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.
New Client Forms
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In Person COVID Precautions
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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Client Intake FormList 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 Disclosure FormList 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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Surprise Billing 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
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Financial Agreement
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 Policy
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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Treatment Goals
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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Tele-therapy Agreement and Consent
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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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
