Patient Forms

Parkside OBGYN & Medical Spa Patient Forms

At Parkside OBGYN & Medical Spa in Denver, we value your time as much as you value ours! To reduce your wait time, please print out the following forms, fill them out completely, and bring them to your next gynecology, obstetric, or medical spa appointment. For medical patients only, you may use our Patient Portal. For spa patients, please download the form below.

All forms must be completed prior to your first appointment. Your medical privacy is always a concern. Click here to view our HIPAA Privacy Policy.

Medical Patient – Please fill out these forms (click to view & print) or use our Patient Portal:

Spa Patient – Please fill out this form (click to view & print):

Parkside OBGYN & Medical Spa Insurance Information

Parkside OBGYN & Medical Spa participates and is in network with most health insurance companies. We will automatically bill them for any covered gynecology or limited obstetric service and will accept their payments as required by our contracts. If you do not have insurance, we expect payment at the time of service. We do not bill insurance for any aesthetics or spa treatments as they are not covered services. These services must be paid at the time of service.

Patients are ultimately responsible for the payment of their bills. You will be responsible for any services not covered under your contract or for services rejected by your insurance company for any reason. Patients are also responsible for any copays, coinsurances or deductible amounts as required by their plan. We reserve the right to require deposits or payment in full for services when we calculate in advance that you will owe such amounts under your plan or for services that your insurer will transfer to patient responsibility.

Parkside OBGYN & Medical Spa in Denver participates with the following health insurance plans:

  • Aetna
  • Anthem Blue Cross/Blue Shield CO and BLUECARD PPO (non-Colorado HMO plans are generally not covered)
  • Beechstreet
  • Cigna
  • Coventry/FirstHealth
  • Galaxy
  • Humana PPO
  • Kaiser Choice through PHCS (not standard Kaiser)
  • Medicare (Standard and Railroad)
  • Multiplan/Viant Network
  • Private Health Care Systems (PHCS) National PPO
  • Rocky Mountain HMO
  • TriCare West (standard plan only–not PRIME)
  • United Healthcare
  • USA MCO

Network Exclusions: At Parkside OBGYN & Medical Spa in Denver, we are generally in network for the listed plans, but some plans and employers have limited networks that do not cover the whole network for the gynecology and limited obstetric services we offer.  Narrower networks are being created all the time without our knowledge. Prior to an appointment, We strongly recommend that you check your insurance company to see if Beth Roland, M.D. is in network. Also, the above list is not exclusive and you should check to see if we are in your network if not listed.

As part of your care, we may need to use additional outside medical/lab services. We do not bill for labs, anesthesia, hospital stays, assistant surgeons, and other outside services that you may receive as a patient. These will be billed by the outside labs, doctors, hospitals or other facilities involved. We try but cannot guarantee whether these outside doctors/hospitals/labs are in your network.

Your medical privacy is always a concern. Click here to view our HIPAA Privacy Policy.

If you have any questions about insurance, billing or need help with the patient forms, call the Parkside OBGYN & Medical Spa staff in Denver at (303) 758-0072 or use our Contact Us page for more information.