Talk to your doctor or find a doctor near you. They should be able to help you fill out your application, notarize, and submit it. This form must be filled out extremely legibly since a single mistake will disqualify your application. For this and the reasons stated above we highly recommend you get your doctor’s assistance filling out the form.
If you are filling out the form yourself take note that the notary may not be the caregiver, patient’s physician or person signing the form of payment. Make sure the date of the signature and notary are the same. Forms must be submitted within 10 days of the notary’s signature.
Once you have finished filling out the application, submit all of your paperwork in one envelope. Here is what your complete application should include:
– A completed, signed and notarized application form
– Physician’s Certification Form signed by your doctor at the time of your evaluation
– Copy of your identification
– A clearly legible copy of your Colorado driver’s license or state ID
– A clearly legible copy of your out-of-state driver’s license or state ID, and proof of residency such as a pay stub or utility bill.
If you don’t have a Colorado ID, you will need to fill out this Proof of Residency Form.
– Application Fee -or- Fee Waiver/Tax Exempt Status Form
– Cash and temporary checks are not accepted for the fee, write a check or money order payable to CDPHE for the amount of $35.00. Include the patient’s name on the form of payment.
– If you are submitting a Fee Waiver/Tax Exempt Status Form, also send a certified copy of your most recent Colorado tax return
– If you are mailing your application, send it via certified mail to this address:
HSV – 8608
4300 Cherry Creek Drive South
Denver, CO 80246 – 1530
– If you are dropping off your application please go to the southeast entrance of Building C at the Colorado Department of Public Health Monday – Friday from 7:00a – 6:00p. The box is located inside the first set of glass doors. The address of the location is 710 S. Ash Street, Denver, CO 80246-1530
– Submit all application components in one sealed envelope
– Send your application by Certified Mail if you would like a receipt of your submission of your Red Card application (this is recommended because you have confirmation they received your envelope and makes it less likely for someone to steal your check/money order)
– If you make a mistake, complete a new form. Do not cross-out, write over or use white-out to correct information
– Send only one application per envelope. If more than one application is sent in one envelope they will be rejected
– Forms must be sent within 60 days of your Physician’s Exam