• Denver Office (303) 320-7366
  • Highlands Ranch Office (303) 471-0221

New Patient
Registration Packet

Thank you for choosing Rose Pediatrics for your child’s health care needs. Please complete this packet and bring it with you to your child’s first appointment.

Medical Records
Release

Please complete this form if you would like to transfer records to Rose Pediatrics or if you would like to transfer records from Rose pediatrics. Due to HIPAA regulations, we ask that you complete a separate form for each child.

Authorization for
Treatment of a Minor

Please complete this form if someone other than the parent or legal guardian will be accompanying your child to his or her appointment.