We are taking steps to protect our patients, staff and the community from COVID-19.

Patient Health Insurance Information

It is critical Peak Primary Care has your most up to date insurance information prior to your appointment. Accurate insurance information will help us ensure you and your insurance are billed properly for services.

If you have not updated your information with us since January 1, 2020, please carefully complete the form below. If you need assistance, call us at 303-452-2766.

Patient Information
Primary Insurance

(found on the back of the card)

(found on the back of the card)

Health Plan Subscriber Name (ie, who is the primary person on the insurance)
Secondary Insurance


(found on the back of the card)

(found on the back of the card)

Health Plan Subscriber Name (ie, who is the primary person on the insurance)
Tertiary Insurance


(found on the back of the card)

(found on the back of the card)

Health Plan Subscriber Name (ie, who is the primary person on the insurance)