Please submit intake form below before your scheduled appointment time.

Print & complete HIPAA and Colorado Mandatory Disclosure Notice form and bring with your to your appointment.  Time will not be added to appointment time if forms are not complete upon arrival. I appreciate your understanding.

 

New Patient Intake Form

This is a confidential questionnaire to help me determine the best treatment plan for you.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY