New Client Forms

New Client Forms

 

Please print and complete the forms, then bring them with you to your appointment.

 Adult Mental Health  Substance Use Disorders (SUD) Child and Adolescent 
 Adult Assessment - English  SUD Assessment - English  Child Assessment - English
 Adult Assessment - Spanish  SUD Assessment - Spanish  Child Assessment - Spanish

Pregnancy Related Depression Screen

This screen should be completed by any
woman who is pregnant or has a child
under one year of age.

 Pregnancy Related Depression Screen

This screen should be completed by any
woman who is pregnant or has a child
under one year of age.

ADHD - SWAN

This form needs to be completed in two
different environments by two
different persons, such as a teacher
at school and a parent at home.

 


 

For questions or more information, please contact your local county office.

Cheyenne County 

(719) 346-8183 

 Elbert County

(303) 646-4519

 Lincoln County

(719) 775-2313

 Logan County

(970) 522-4392

 Morgan County

(970) 867 -4924

 Phillips County

(970) 854-2114

 Sedgwick County

(970) 474-3769

 Washington County

(970) 345-2254

Yuma County

Wray:  (970) 332-3133

Yuma:  (970) 848-5412

 
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