Skip to content
×
Doctors
Services
Locations
Schedule Appointment
Help me find…
Search
Search
Online Bill Pay
About us
My Health Connection
Classes & events
Blog
Providers
Employees
Careers
Careers
Providers
Employees
Language
What are you looking for?
Doctors
Services
Locations
Other
< Back
What are you looking for?
Help me find…
Search
Online bill pay
My Health Connection
Classes & events
Blog
About us
Doctors
Services
Locations
Schedule Appointment
UCHealth Specialty Care Clinic - Woodland Park
16222 W. Highway 24, Suite 210
Woodland Park
,
CO
80863
16222 W. Highway 24, Suite 210,
Woodland Park
,
CO
80863
719-686-2832
View map
Home
Locations
UCHealth Specialty C...
About
Services offered
Ear, Nose, and Throat (ENT)
Gastroenterology
Pulmonary (lungs and respiratory)
Help me find…
Search
Search
×
Close
Contact us
Contact us
This is NOT for medical emergencies. Call 911 if you have a medical emergency.
Reason for Email
*
Please select an option below
Billing
Careers
My Health Connection - Technical Support
Name
*
First
Last
Contact Phone Number
*
Email
*
Zip
*
Birth Date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Last 4 Digits of your Social Security Number
*
Comments or Questions
Up to 1000 characters may be entered.
NOTE Support Hours: M - F, 8 a.m. to 5 p.m. (MT). Please allow up to one business day for a response.
Name
This field is for validation purposes and should be left unchanged.
This iframe contains the logic required to handle Ajax powered Gravity Forms.
×
Refer your patient now
Patient’s information
Name
*
First
Last
DOB
*
Phone number
*
Insurance
*
Referring provider information
Name
*
First
Last
Specialty
*
Location
*
Phone number
*
Referral
(No radiology orders, please)
Department/specialty referred to
*
Preferred location of consultation
Diagnosis
*
Priority
*
Routine
ASAP
Urgent
Please send any pertinent, clinic records related to the DX to prl@uchealth.org
Name
This field is for validation purposes and should be left unchanged.
This iframe contains the logic required to handle Ajax powered Gravity Forms.