Forms

If you wish to save time in your initial consultation session, you may print and fill out these intake forms and bring them to your first meeting.  (Please note, we will go through the forms in session to give you the opportunity to ask any questions you may have).

Client Information Form

Youth Client Information Form (if client is under 18 years old)

Disclosure Statement

Telehealth Consent Form (optional)

Payment Agreement

Consent to Release/Request Information Form (optional) You may wish to save this form for your first meeting with Dr. Karwan.

HIPAA Notice of Privacy Practices – it is highly advised that you print and read this form prior to your first meeting.

No Surprises Act notice of your rights and protections against surprise medical bills

If you would like to schedule your FREE 30-minute consultation session, you may contact Dr. Karwan by phone at (970)631-5400, or by filling out the form below:

    Name:

    Phone number:


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    E-mail:

    Preferred method of contact:

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