Choose the form that fits

Service inquiry

Ask about care for yourself or someone in your family. No medical details.

Caregiver application

Apply as a caregiver or IHSS family attendant. No Social Security number.

IHSS family caregiver interest

Tell us you want to ask about getting paid to care for a family member.

Satisfaction survey

Rate your experience and say whether we may quote a comment.

Complaint or grievance

Tell us what happened. You can leave your name off. CDPHE and HCPF contacts are on the page.

Client Intake

For a new client’s identity, coverage, contacts, schedule, and health information. Those details stay on a HIPAA-ready form, not on this website.

Professional Referral

For case managers and other professionals sending a referral that includes coverage or health information.

Authorized Representative

For naming a person who may speak for a Health First Colorado member, with signatures.

Release of Information

For written permission to share information with a named person or agency.

HIPAA Acknowledgment

For acknowledging receipt of the Notice of Privacy Practices, with a signature.

Schedule Change Request

For a change to an authorized schedule when the request may include health information or a client identifier.

Incident Report

Staff only

For staff reporting an incident. This page is not a private intranet. The report itself belongs in the HIPAA form tool.

EVV / Timesheet Issue

For caregivers and office staff reporting a visit-verification or timesheet problem that may identify a client.