forms and

RELEASES

Demographics

If you are a first time client, either complete the demographics online or please print and complete the form with all your personal and insurance information and bring it to your initial session.

Initial Therapy Intake

If you are a first time therapy client, please print and complete the initial intake form and bring it to your initial session.

Initial Adult Neuropsychological Evaluation Intake

If you are an adult age 18 or above and coming in for a neuropsychological evaluation, please complete the initial intake form prior to your first session.

Initial Child/Adolescent 

Neuropsychological Evaluation Intake

Please complete the initial child/adolescent intake form for a child under the age of 18-years coming in for a neuropsychological evaluation.

Telemental Health Consent

If you will be engaging in any remote health services with any of our providers please complete the following consent form.

Release of Information

Please print, review, and sign the limits of confidentiality and cancellation policy forms and bring it to your initial therapy or evaluation session.

Confidentiality Limits and Cancellation Policy

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information.

Adobe Acrobat Reader

You can download Adobe Acrobat Reader for free.

*All our online submitted forms are HIPAA compliant, and we utilize strong security standards to makes sure all private health information is secure and protected when transmitted online. 

190 East 9th Avenue

Suite 350

Denver, CO 80203

(720) 449-2499 Phone

(720) 634-0719 Fax

admin@rmnpc.com

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