GVFP Forms

Please print the required form below, fill it out, and bring it with you to your first appointment.  All forms are in PDF format.  Download free Adobe Acrobat Reader to view PDF forms.

General Forms

CDC Immunization Schedules

Pediatric Checkup Questionnaires

GVFP recommends that we see your child for a well-child checkup at the following ages:

First year: 2 months, 4 months, 6 months, 9 months, 12 months.
Second year: 15 months, 18 months, and 24 months.
Every year thereafter: 3, 4, 5, 6, 7, etc.

For your child’s 6 month, 12 month, and 24 month checkups, we would like you to fill out an ASQ form.  We are no longer permitted to provide the ASQ forms online due to copyright issues. We would be happy to send you an ASQ Questionnaire. Please fill out the short form below to request a copy.  Be sure to include the age of your child.

Request Pediatric Checkup Questionnaire ASQ Form(s)


    Address: 130 E. Virginia Ave.
    Gunnison, CO 81230
    Main Phone: (970) 641-0211
    Fax: (970) 641-1268
    M-F 7:45 am – 5:00 pm
    Sat. 9:00 am – 12:00 pm
    Answering Service available after-hours.

    Address: 214 6th Street, Suite 1
    Crested Butte, CO 81224
    Main Phone: (970) 349-6749
    Fax: (970) 641-1268
    M-F 9:00 am – 6:00 pm
    Sat 12:00 pm – 6:00 pm

    Business Office:
    (970) 641-2241