Medical Records and Health Form Requests
Medical Records Requests
Please click here to print the authorization form needed to request copies of your child’s medical records. A valid photo ID, of the legal guardian/parent or patient themselves if 18+ is required for release of medical records. Patients over the age of 18 must request their own medical records. Once the form is complete, please choose ONE of the following options:
- Drop off the authorization form at any of our locations
- Mail the authorization form to The Youth Clinic 1200 E. Elizabeth Street, Ft. Collins CO 80524 location
- Fax to (970) 416-6299
Our turnaround time is typically 7 business days.
*Fees for Medical Records Requests copy services are as follows:
- To Patient or Legal Guardian:
- Free through My Health Connection and secure email delivery (all pages).
- Free for 1-10 pages Paper Delivery: 11-99 pages are $6.50.
- Free for 100 or more pages delivered electronically only.
- To Third Party recipient:
- $18.53 (retrieval fee for pages 1-10) plus $0.85 (each pages 11-40) plus $0.57 (each page over 40).
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Patient Health Form Requests
Effective 3/1/24, please be aware that completion of FMLA (Family Medical Leave Act) forms will require a visit with your child’s primary care provider due to the complexity and time required for completion of these forms. You must bring your FMLA paperwork to the visit in order for it to be completed, as these will not be completed after the visit or by our administrative nurse team.
Health Forms Request & Return Process
Health forms requested and completed outside of your child’s well care visit will be subject to a fee.
Common health forms may already be available through your child’s My Health Connection (MHC) patient portal account.
Immunization Records may be requested for free through the Colorado Immunization Information System’s (CIIS) public portal here.
Health Form Requests FAQ at the bottom of the page will help answer most questions you may have.
Before you request a health form, please note:
Patient must be current on their well care visits in order for a form to be completed.
- If patient is over the age of 3 yrs, a well care visit within the last 12 months.
- If patient is less than 3yrs, a well care visit per AAP guidelines
Click Here to view the Well Care Visit schedule or call our office at (970)267-9510 to check if your child’s well care is up to date.
Request Options for a Health Form:
1. Electronically requested by completing form below and/or uploading any needed form.
2. Dropped off in person at the E Elizabeth office location.
3. Mailed to our East Elizabeth office located at 1200 East Elizabeth, Fort Collins CO. 80524.
We no longer accept health form requests via voicemail or FAX.
Don’t have a form? No problem, commonly requested fillable forms are also an available option for selection below
Receiving Options for a Completed Health Form:
1. Electronically by secure email. Be sure to check your Junk/Spam email folders!
2. Pick-up at the East Elizabeth location. At this time, the E Elizabeth office is only location available for in person form requests or pick up of completed forms.
3. Our emails are sent securely through Barracuda requiring you to create your own password to open.
Form requests require payment prior to submission.
Parents/patients/guardians are responsible for returning completed health forms to child’s school, daycare, camp, etc.
Form Charges
Free
Completed at time of well care visit
- Basic forms
- Non-Complex forms
$10 Basic Form
7-10 business days turnaround, includes up to 2 requests
- Daycare Health forms
- Sports Physical forms
- Medication Release forms (1-5 Meds)
- Camp forms
$40 Rush Form
- Completed by end of next business day
- Basic forms only
- Unable to Rush
- Scuba Diving Forms, Overseas Travel Forms of any variety, Extensive Camp Forms and Requests of 5 or more Medication Releases.
- Rush requests are returned at the end of next business day
Health Form Requests
Below are the most commonly requested forms. If your form is not listed, please select the “Upload A Form Not Listed”.
Medication Authorization & Release
Authorization and Release For Administering Medicine to Student at School or School-Sponsored Activity
Before submitting Medication Release, please check our Approved Over the Counter Medication List
Click here to fill out the Medication Authorization & Release
2023-2024 PSD MS Sports Form
2023-2024 Middle School Physician Certification of Student Fitness for Athletic Participation
Pre-Participation Physician Clearance
CHSAA Pre-Participation Physical Evaluation
Click here to fill out the Pre-Participation Physician Clearance
Colorado Asthma Care Plan
Colorado Asthma Care Plan and Medication Order for School and Child Care Settings.
General Health Appraisal Form
General Health Appraisal Form
2023-2024 PSD High School Athletics Form
2023-2024 High School Physician Certification of Student Fitness for Athletic Participation
Click here to fill out the 2023-2024 PSD High School Athletics Form
Upload a Form Not Listed
Give us some basic information and upload a blank copy of a form you need completed
Health Form Request FAQS
How are FMLA (Family Medical Leave Act) forms completed?
*Effective 3/1/24, completion of FMLA (Family Medical Leave Act) forms will require a visit with your primary provider for completion due to the complexity and time required for completion of these forms. You must bring your FMLA paperwork to the visit in order for it to be completed as these will not be completed after the visit or by our administrative nurse team.*
I can't find the email with my invoice and form.
You may need to check junk or spam email folders for your form.
Why are you now charging for health forms?
Health forms completed outside of the well care visit now require us to assess a nominal fee for completion as we receive a very large volume of requests daily that requires additional staff and time and expertise. We spend a great deal of time before we apply a signature to any form, reviewing charts, current well visits and medications, and want to continue offering a high level of customer service while giving adequate time and attention to each request.
Which health forms are free at my Well Care Visit?
You will receive a general health form and/or sports physical form and any required medication releases at your well care visit for free. For convenience and future access, these forms can be printed and/or pushed to your patient portal (MHC- My Health Connection). This will only be an option for patients who have a current active portal account. You then will be able to access and reuse forms sent to your patient portal for those times you might need a second or third copy during your current well care year.
If you currently do not have a My Health Connection portal account, please click here for more portal information and how to sign up for an account.
What are the charges for forms completion?
Cost is $10 for 7-10 business day turnaround time for most Basic Forms.
$40 is the charge for expedited (Rush) requests. Turn Around Time End of Next business day.
Please note not all forms can be rushed. Please see $40 Rush Forms Section.
How do I pay for my health form request?
You will prepay for your form request prior to submission of form on our website, www.youthclinic.com
What hasn’t changed in the Forms Request Process?
A current/up to date well care visit is needed to complete health forms. For patients 3 and older a well care visit within the past 12 months. For patients under 3 we follow current AAP guidelines, click here for the well care visit schedule.
Our staff will continue giving adequate time and attention to each request and notifying parents with any issues that arise during the form’s completion process.
Completed forms will be returned to parent/patient/guardian via secure email or available for pick up at E Elizabeth office.
How do I know if my form is complete/Can I call and check on the status of my form?
We are busy completing a large volume of forms daily and do not accept calls checking on the status of forms.
You will know your form request is complete when you receive a secure email with your completed form 7-10 business days after submission.
If you requested to pick up your completed form at the East Elizabeth Office we will also email that your form is complete and ready for pickup.
Please be sure to check your Span/Junk Email Folder after 10 business days.
What is the E Elizabeth’s office (1200 E Elizabeth St) availability to drop off health form requests?
Mon- Thurs 8am-4pm
Fri 8am-2pm
Website online requests are available 24 hours a day 7 days a week