Broomfield Pediatrics
& Internal Medicine

"We know that we hold the world's tomorrow in our hands when we hold children in our arms today."
3301 W 144th Ave., Ste. 200
Broomfield, CO 80023
(303)438-5522
Office Hours: 8:30-5:00
Monday-Friday Lunch: 12:00-1:30
Dr. Nancy Greer Dr. Gene Gonzales Dr. Thomas Pham Rebecca Barnes PA-C

Appointment Check-in documents

To expedite your appointment check-in, you may fill out the appropriate form(s) below to bring with you to your appointment. Most of the forms are available in a fillabe PDF format with appropriate input fields. If you are having trouble viewing the document please open it up in Adobe Reader.

Transfer In Consent to Release of Records of medical information

Kaiser Release Form

Patient Information

HIPPA - Consent Form

Patient History

Family History

Permission to Treat Children

Spouse Release

Miscellaneous documents

Policies & Procedures

Financial Policy

HIPAA - Notice of Privacy Practices

Understanding Child Well-Care Visits and Checkups

CO Asthma Form

Anaphylaxis(Epi Pen) Plan

Urgent Care locations, phone numbers.

Vanderbilt Parent Initial

Vanderbilt Parent follow up

Vanderbilt Teacher Initial

Vanderbilt Teacher follow up

Acters