Centura Health has more experts in more places throughout the region. Start your health journey by finding the right one for you.
One or more of the following forms may be needed prior to your procedure or if you are picking up medical records/films. If you are not sure which form(s) you need to complete, please call 719-776-5135.
If you plan on having a CT, Nuclear Medicine exam, or diagnostic radiology procedure (Video and Barium Swallows, Esophagrams, Bone Surveys, IVP Urography, Joint Injections,etc) please complete, print and bring the following form to your appointment..
Patient Medical History Form
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