Forms

Untitled-1Forms

Please click on the forms below to download a copy. These forms are in PDF format and require that you have a copy of Adobe. If you do not have a copy of this program you can download Adobe Reader for free here: http://get.adobe.com/reader/ These forms are provided for your convenience and to save you time at your first visit. Please print these forms, complete them, and bring them with you when you first come to our office. Please be advised that these forms are for the purpose of providing us with your important information for your initial evaluation. Completing these forms does not schedule an appointment with us, nor does it guarantee coverage for your visit(s) by your insurance company. To schedule a visit, please cal our office. To verify insurance coverage, please contact your insurance company prior to your visit. If required by your insurance policy, please also obtain a referral from your doctor before your first visit.

Please feel free to call me with any questions at: 720-938-3503

Intake FormIntake Form
Intake FormROI (Release of Information)
Intake FormDisclosure Form
Intake FormAdditional Disclosure Form
Intake FormCC Payment Form

Intake FormConsent to Treat a Minor
Intake FormChild Information Form
Intake FormAdolescent Information Form