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About > Patient and Provider Forms

 

All the forms you need, are right here (don't you wish everything was?). 

 

Patient Forms

 

Please download and print forms A through D (below), complete and then sign!

Please download and print Form E if you will be joined, during the initial consult, by a non-family member, friend or other trusted companion.

 

To expedite your care, feel free to mail all forms ahead of time to our -administration- office, or simply bring them with you when you arrive at our -clinical- office. Fifteen (15) minutes early is recommended!  

 

Provider Forms

 

Please download and print form F (below) and confidentially forward to our administration office. 

Note that a referral must be complete prior to your patient being scheduled.  

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Patient Forms   

(please note where signature is required)

 

A. Welcome and Patient's Rights and Practice Policies

 

B. New Patient Registration and Pre-Visit Questionnaire

 

C. HIPAA PHI Notice of Providers’ Policies and Practices to         Protect the Privacy of Your Health Information

 

D. HIPAA Records Authorization to Release To and From

 

E. Collateral to Patient Agreement

 

Provider Forms

 

F. New Patient Provider Referral

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Confused with all this paperwork? (Whew, us too). 

Give us a call at 303-242-3510, and we'll walk you through. 

We're always happy to help!

PATIENT and PROVIDER FORMS

Classification Systems and Patient-Provider Reports

 

When a diagnosis is suggested or supported, our classification system adheres to ICD-10 and DSM-5 criteria, standards and guidelines.  

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As always, when your consult and follow up visit(s) are complete, we'll review all qualitative and quantitative data and findings with you, and have a take-home document for you to review at your leisure. We want you to understand all diagnostic, prognostic and treatment planning recommendations.

 

Your patient chart, clinical record, and timely communications help to facilitate consensus and clarity for all involved. Please let us know if there is anyone on your team that is missing. We'll get them included. 

Tech savvy and want to streamline everything? 
 
  1. Ditto for all the above but then scan them into your computer.
  2. Then Contact Us and we'll send you a personalized link where you can securely upload all forms.
  3. Then head to your favorite dance hall . . . we'll do the rest!

Have confidential documents?

 

Have confidential documents such as Medical Records, Labs or Test Results you need to send to us? Contact Us and we'll send you a personalized link where you can upload almost any document, image or file. 

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