Veterans Community Living Center at Fitzsimons admissions

Admissions forms

Please contact us before filling out an admissions form to verify eligibility. Once we receive your application and medical records, we will review your information within a week. You may reach out at any time to inquire about your application’s status.  

Online admissions form

Fill out the Fitzsimons admission form online.

Print-friendly admissions form

Download and print the Fitzsimons admission form.

Document checklist for application

Before you fill out our application form, please make sure you have the following documents.

Applicant information

• Completed and signed Admission Form
• Completed and signed Authorization for Release of Information
• Verification of Veteran Status (form DD-214 or Military Honorable
• Discharge and Enlistment Record)
• Any Power of Attorney or Medical Power of Attorney paperwork

Identification

• Photo ID
• Social Security card

Insurance/payer information

• Copy of VA Service-Connected Disability award letter
• Copy of Medicare card
• Copy of Medicaid card
• Copy of Tricare card
• 6 months of bank statements
• Current statements of annuities and/or assets
• Documentation of income

Additional required information for veteran spouses or Gold Star parents

• Marriage certificate (if veteran spouse)
• Death certificate (if Gold Star parent)