Welcome to The Center for Integrative Medicine at the University of Colorado Hospital. We are committed to serving you and your health care needs. Our team of health care professionals knows trust and confidence are earned, not assumed. We value your selection of us and look forward to earning your trust. Appointments Call 720-848-1090 and press 3 to speak to a clinic representative who will schedule, adjust, or cancel your appointment. Cancellations We ask you to call 24 hours in advance if you need to cancel an appointment. Cancellations that occur with less than a 24-hour notice are considered a No Show. In order to provide timely appointments and allow access to our providers we monitor No Show appointments. A notification letter will be sent after the first and second missed appointments. After the third missed appointment you may be discharged from the practice. If you missed your appointment due to hospitalization or other unforeseen circumstances, please let us know and you will not be penalized. For more information regarding this policy please ask a front desk representative. SERVICES OFFERED Payments/Insurance Many of the services provided at The Center for Integrative Medicine are not covered by insurance. In those instances when services are covered and University of Colorado Hospital is a contracted provider, we will work with you to obtain necessary authorization from your insurance company. We bill as a facility and thus some plans have a different deductible, coinsurance or co-pays reflective of this. If this is the case, you will be billed for the additional amount and responsible for payment as you are held accountable for understanding your plan. If you check your benefits, be sure to specify that we bill as an outpatient facility. If you have questions about what this means, please contact us so we can provide any clarifications on the difference from professional billing. Cash, check, Discover, MasterCard, Visa or American Express are accepted methods of payment. Payment is due at the time of service. Your Visit We ask that you arrive 15 minutes ahead of time to ensure a smooth flow through the registration. Please bring a photo ID, your insurance card and your co-pay amount if required. Self-pay patients must pay at the time of check-in. Biofeedback Chiropractic Therapy Counseling Behavioral/Psychological Spiritual (in conjunction with pastoral care) Massage Therapy Integrative Medicine Health and Wellness Consultations (Covered by most plans) A physician or physician’s assistant will provide individual personalized advice on blending complementary medicine with conventional care for patient who: -Have a complicated diagnosis -Are uncertain which complementary and alternative medicine service would best meet their needs -Would like general wellness advice Nutritional and Dietary Counseling Pharmaceutical/Herbal Supplement Consults Traditional Chinese Medicine (TCM) Acupuncture Chinese Herbal Supplements/Consultations Workshops and classes For more information on classes please contact The Center for Integrative Medicine THE CENTER FOR INTEGRATIVE MEDICINE ANSCHUTZ OUTPATIENT PAVILION 1635 Aurora Court, MS F743 Fifth Floor, Suite 5501 Aurora, Colorado 80045 Directions (please click link below or view webpage): http://www.uch.edu/imgs/map/TCFIM_AOP_Map.pdf My Health Connection (MHC) You are able to securely manage your health care from the comfort of your own home by signing up for our free online service. MHC allows you to request an appointment, request prescription refills, view your labs online, communicate with your provider, and update your insurance information. www.uch.edu/myhealthconnection Medical Records You may obtain medical records by calling 720-848-1031. Please remember in order to obtain your medical records and to allow a family member and/or spouse to obtain your medical records, a medical release form must be signed. P: 720.848.1090 | F: 720.848.1277 Clinic hours: Monday through Friday 8:00-4:30pm Check out our Facebook and LinkedIn pages: “The Center for Integrative Medicine at University Colorado Hospital” or view our webpage through the link below: http://www.uch.edu/integrativemed MEET THE TEAM Anyone on our team can assist you with general questions about our services, your appointment, scheduling, taking payments, product sales, referrals, medical record requests, receiving our enewsletter or My Health Connection. Please read about our Care Team members and their positions so you know who to refer to for any specific issues or questions you may have. Steve Tung, Practice Manager Phone: 720-848-1080 / Email: Stephen.Tung@uchealth.org If you have questions, comments, concerns or inquiries regarding the service you received at The Center for Integrative Medicine. Kayla Engebretson, Care Team Specialist Phone: 720-848-1061 / Email: Kayla.Engebretson@uchealth.org If you have questions regarding billing issues, insurance authorization, or IVF acupuncture. Tina Gillett, Medical Assistant & Care Team Assistant Phone: 720-848-1091 / Email: Tina.Gillett@uchealth,org If you have medical-related questions, prescription refill requests, or questions on a psychology referral. Katie Hodgson, Care Team Assistant Phone: 720-848-1788 / Email: Katherine.Hodgson@uchealth.org If you are not sure who to refer your inquiry to and need additional support, please refer to Katie for guidance. NAME: __________________________ DATE OF BIRTH: ___________________ 1635 Aurora Court, Suite 5501 Aurora, CO 80045 Phone: 720-848-1090 Fax: 720-848-1277 The Center for Integrative Medicine: Health and Wellness Assessment Emphasizing wellness and healing through the integration of Western and complementary medicine. How did you hear about our center? Brochure Newspaper/Radio/TV Internet Walk-in Conference/Lecture/Seminar Word of Mouth Physician/Nurse/Other: ____________________________________________ (Please write in name) Reasons You are Seeking Care: Please list any specific symptoms you would like help with below. If you are not experiencing any symptoms please note below your health goals related to this visit. Please rate your primary complaint of __________________________ or current pain level, from zero (no pain/complaint) to 10 (worst): 0 1 2 3 4 5 6 7 8 9 10 What have you done to help the problems listed above? _____________________________________________ __________________________________________________________________________________________ How do these symptoms affect you? ____________________________________________________________ __________________________________________________________________________________________ Please state your treatment goal(s): _____________________________________________________________ __________________________________________________________________________________________ If you are seeing the chiropractor, please list dates of any pertinent spinal x-rays, MRI or CT scans please list the areas images (i.e. Neck X-Ray August 2012): _______________________________________________________ ___________________________________________________________________________________________ General Interest in Complementary / Alternative Medicine Therapies: Please check the therapies you may be interested in discussing: Psychological Counseling Nutritional/Dietary Counseling Mind/body therapies Spiritual Counseling Herb/Supplement Counseling Stress Management Chiropractic Acupuncture / Chinese Medicine Massage Therapy Other (please list): ________________________________________________________________ Are you interested in receiving our e-newsletter? YES NO If yes, please provide us with your email: _____________________________________________