Download your Bloom Mental Health patient forms below.
After downloading and completing, please email your forms to [email protected] or fax them to 720-306-5515
After downloading and completing, please email your forms to [email protected] or fax them to 720-306-5515
ADA Notice
If you are a person with a disability and you need assistance completing any of our forms,
please call our office at 303-801-1776.
We are happy to assist.
If you are a person with a disability and you need assistance completing any of our forms,
please call our office at 303-801-1776.
We are happy to assist.
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PDF FORM VERSION
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ONLINE FORM VERSION
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New Patient Forms
| Patient Contract |
| Release of PHI Authorization |
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In Person Services Consent
Complete the Online Form Instead | ||
| Notice of Privacy Practices |
| Electronic Payment Authorization |
Ketamine Therapy Forms
| Instructions for Day of Ketamine Session |
| Ketamine Treatment Consent |
| Ketamine Electronic Payment Authorization |
| How To Get The Most Out of Your Ketamine Infusion |
Botox Therapy Forms
| Pre and Post Treatment Instructions for Botox |
| Botox Treatment Consent |
| Botox Electronic Payment Authorization |
Oxygen Therapy Forms
| Oxygen Therapy Consent |
| Oxygen Therapy Payment Form |