Forms & Other Useful Information

Forms l Directions l After Hours l Phone Numbers l Office Holidays
 In Patient Care l Insurance

Forms for Your Visit

By completing the following forms prior to your initial visit you can save considerable time at check-in.

All forms are in pdf format which can be opened by Adobe Reader. If you do not have Adobe Reader installed, you can download it now at www.adobe.com.

• Authorization for Disclosure of Health Information (Medical Release Form)

• Birth - 12 Month History

• New Patient Health History

• Patient Information/HIPAA

Skin Care Treatment Consent Forms

• Botox Consent Form

• Client Information

• Hair Removal Consent

• Juvederm Consent Form

• Microdermabrasion Consent Form

• Photofacial Consent Form

• Removal/Reduction of Brown/Age Spots, Rosacea & Spider Veins Consent Form

Directions

Address:  1411 S. Potomac, Suite 300, Aurora, CO 80012  Map

We are located right next to The Medical Center of Aurora on Potomac between Mississippi and Iliff.

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 After Hour Emergencies

For our established patients, there is a doctor on call 24 hours a day. To reach the doctor on call please call
303-531-4910

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Important Phone Numbers

Main Line: (303) 531-4910 Fax:  (303) 309-3733 Prescription refills: Please contact your pharmacy The Medical Center of Aurora (303) 695-2600

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Office Holidays Observed

Cornerstone Family Practice physicians practice O.B. and have hospital privileges at The Medical Center of Aurora.

We provide O.B. and newborn care only. All other in patient care will be provided by the hospital in-patient care team.

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Insurance Information

The following Insurances are accepted at Cornerstone Family Practice:

Aetna HMO/PPO/EPO/POS Alliance Anthem Blue Cross / Blue Shield Beech Street Cigna HMO/PPO Cofinity GEHA Great West Humana Mail Handlers One Health HMO/PPO/POS Pacificare HMO PHCS EPO/POS/PPO Rocky Mtn HMO Commercial TriCare Standard United Healthcare HMO/PPO/EPO

If your insurance is not listed above, please call Cornerstone Family Practice Phone Numbers

Forms l Directions l After Hours l Phone Numbers l Office Holidays
 In Patient Care l Insurance

Cornerstone Family Practice
Dr. Lisa Gieseke, D.O.
1411 S. Potomac, Suite 300, Aurora, CO 80012   Map
Phone: 303-531-4910 - Fax: 303-309-3733
E-Mail: DrGieseke@cornerstone-fp.com
Office Hours: Monday - Friday 8:00am - 5:00pm