Group Therapy Waitlist
Even when our groups are full, we're happy to contact you when they are accepting clients again.
Submit your information below to add yourself to the waitlist, and email
with any questions in the meantime!
Sign in to Google
to save your progress.
Who should we out to for scheduling?
First and Last Name (please include pronouns)
I'm looking for services for...
Client (who will be receiving services) First and Last Name (please include pronouns)
If you're filling the form out for yourself, you can list "Self" in this section.
Date of Birth
Who is your Insurance Provider?
Blue Cross Blue Shield
Rocky Mountain Health Plans - Medicaid
Northeast Health Partners - Medicaid
Never submit passwords through Google Forms.
This form was created inside of Colorado Center for Assessment & Counseling.