IF YOU ARE HAVING A MEDICAL EMERGENCY, PLEASE CALL 911
This information may take several days to proccess from this website and it is not designed to manage emergency situations.
If you would like to become a client of our PACT program or have been advised to do so by your physician, please complete the following form in its entirety.
All information submitted via this form is encrypted and handled in strict accordance with HIPAA law.
Thank you for submitting your PACT Client Request form.
We will be contacting you shortly to complete your enrollment process in the PACT program. If you have not heard back from us within a few days, please contact us at (719) 687-2291.
We thank you for you consideration, and we look forward to serving you!
Best regards,
Ute Pass Regional Health Service District