175 Mercado St,
Ste 111, Durango,
CO 81301

Patient Forms

Welcome to our Animas Plastic Surgery Patient Center. In order to expedite your visit with Dr. Naffziger, please fill out our Patient Intake Forms and bring them with you to your appointment.

Patient Forms

You may print them out as blank copies and fill them in manually, or type the information into your computer and print the document.

If more space is needed, please bring your medication lists or additional medical history with you.

In addition to the above completed forms, please bring your insurance card to your appointment. You will be responsible for the consultation fee if we do not have your insurance, workmen’s compensation, or Medicare/Medicaid coverage information at the time of your visit.

Remember, all non-cosmetic consultations require a formal referral from the emergency room or other primary care providers.

With the exception of emergencies, your first visit to the office will be for a consultation only and if any surgery is required, it will be scheduled for a later date. If you have any X-rays, EMG’s or other studies related to your visit, please arrange to bring them with you from your referring doctor’s office. Failure to do so may necessitate rescheduling of your appointment to a later date. All x-rays are performed at Animas Surgical Hospital, Mercy Regional Medical Center, and their ER’s/Urgent Care facilities are accessible on our computers and do not need to be brought in with you.