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For Professionals

Anesthesia Request Form

Financial Agreement

Thank you for your interest in the services of Altitude Anesthesia Group. We have found that it is helpful for you and your staff to meet with one of our anesthesiologists to discuss the basics of office-based anesthesia and how we can work together to accommodate your office’s anesthesia needs. Please note for all non-state funded insurances we do require a deposit prior to scheduling the patient.

We will contact the patient or representatives of the patient prior to the day of treatment to review their health history, go over pre-op instructions, explain the anesthesia experience, and answer any questions.

Unlike when contracting with a nurse or physician anesthesia provider, a separate office inspection is NOT needed prior to the administration of anesthesia in your office.  This is because our anesthesiologist’s equipment and permit travel with them and satisfy the Colorado Dental Board requirements.  See Colorado Dental Rule XIV.L.3,4 (3 CCR 709-1 Rules and Regulations page 37, https://drive.google.com/file/d/0BzKoVwvexVATejBPM0U3TFl6czA/view ). We do require that your office provides at minimum two (2) full oxygen tanks (E cylinder or larger).

We certify to you that appropriate and functional monitoring equipment will be used during the administration of anesthesia. We also certify that all doctors have completed and maintained clinical license certification and carry an active malpractice policy.

We look forward to hearing from you and appreciate your interest. Please contact our office with any questions.


Altitude Anesthesia Group