970-397-4609
Office and Mailing: 206 Clayton Street, Brush, CO 80723
In an effort to expedite the intake process and respect our clients valuable time, we have provided necessary forms below for your convenience.
List of Services
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Client IntakeList Item 1
Download and fill this form out to expediate the initial intake process. Please bring the completed form with you to your appointment or fax it to 970-483-7823
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Mandatory DisclosureList Item 2
Download and fill this form out to expediate the initial intake process. Please bring the completed form with you to your appointment or fax it to 970-483-7823
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Billing DisclosureList Item 3
Download and fill this form out to expediate the initial intake process. Please bring the completed form with you to your appointment or fax it to 970-483-7823
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Therapy AgreementList Item 4
Download and fill this form out to expediate the initial intake process. Please bring the completed form with you to your appointment or fax it to 970-483-7823
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CHTA Privacy Right Notice
Download and fill this form out to expediate the initial intake process. Please bring the completed form with you to your appointment or fax it to 970-483-7823
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Goals in Counseling
Download and fill this form out to fill out goals for treatment. Please bring the completed form with you to your appointment or fax it to 970-483-7823
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Beacon Member Rights
Download and fill this form out to be seen to consent to understanding your rights as a Health First Colorado member. Please bring the completed form with you at your appointment or send it to our fax @970-483-7823
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Coordination of Care
Download and fill this form out to be fill out coordination of care. Please bring the completed form with you at your appointment or send it to our fax @970-483-7823
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Financial Agreement Medicaid
Download and fill this form. Please bring the completed form with you at your appointment or send it to our fax @970-483-7823
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Doreen Hills Disclosure Form
Download and fill this form out to be seen by Doreen Hills. Please bring the completed form with you at your appointment or send it to our fax @970-483-7823
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Allie Hauck Disclosure Form
Download and fill this form out to expediate the initial intake process. Please bring the completed form with you to your appointment or fax it to 970-483-7823
