Please complete all 4 forms (and the Release of Information if it applies to you) one week prior to your initial Intake Appointment.
Please complete this Release of Information (ROI) form if the following applies to you:
1) If you are a minor age 15 to 17 and would like your parents/guardians involved in your treatment
2) If you are an adult and you would like your parents/guardians involved in your treatment
3) If you would like any other individuals involved in your treatment
4) If you would like our providers to consult with any of your other providers, such as your primary care provider, therapist, or nutritionist
5) If you would like us to request records from any of your current or past providers
The Courage Clinic, PLLC
Denver, CO
info@thecouragecliniccolorado.com
phone :: 720-388-8263
text :: 720-706-3375
fax :: 720-216-2276
The Courage Clinic exists to support individuals and families in living courageously by providing exceptional mental health care to all residents of Colorado, while training other clinicians to do the same.
© 2023 The Courage Clinic, PLLC