Health Facilities Letter of Intent
Submission of this request in no way obligates the requester or applicant to open a health facility/agency. The information does allow the Division to track the number of proposed facilities, efficiently handle application requests and to eliminate unnecessary mailings of information packets. Please provide the requested information to the best of your knowledge. If a question is not applicable or is unknown at the time of request, please write “N/A” or “Unknown” where appropriate.

Thank you for your inquiry.

PLEASE NOTE: If you are an existing health facility or agency and have an account through Colorado Health Facilities Interactive (COHFI), you must use the Update Application option available through your Licensing Workbench to report all changes. Do not use this form.
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Requestor Information
Facility/Agency information will be collected on the next page.
Requestor Name *
Email Address *
Phone *
Mailing Address
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