Completed reports can be faxed to: 720-213-1007 OR 720-213-0002
Please make sure your case manager has valid, updated consent forms for all of your providers. Below are links to all consent forms. Each consent form has two pages, one authorizing Peer Assistance Services to speak with your provider and the second page authorizes your provider to speak to Peer Assistance Services. Please make sure you complete both consnet forms and check the appropriate boxes prior to signing the consent form. Completed consent forms may be faxed to (720)213-1007.
General Consent Forms
Consent for Follow-Up Contact - Updated 11/2/10
All Clients
Consent-General-Release AND Non-PHI Receive - Non-Medical - Updated 8/25/09
Consent-General-Release AND PHI Receive - Medical - Updated 8/25/09
Consent-Doctor/Dentist - Updated 8/25/09
Consent-Emergency Contact - Updated 8/25/09
Consent-Employer - Updated 8/25/09
Consent-Norchem - Updated 8/25/09
Consent-Probation Officer - Updated 8/25/09
Consent-Psychiatrist/Psychologist - Updated 8/25/09
Consent-Sponsor - Updated 8/25/09
Consent-Spouse - Updated 8/25/09
Consent-Therapist - Updated 8/25/09
Consent-Treatment Center - Updated 8/25/09
For Nurses
Consent—SBON - Updated 8/25/09
For Dentists
Consent—CBDE - Updated 8/25/09
Consent—School of Dental Medicine - Updated 8/25/09
For Pharmacists
Consent—SBOP- Updated 8/25/09
Consent—School of Pharmacy - Updated 8/25/09
Consent-School of Pharmacy - Regis - Updated 12/7/10
For Fee For Service Clients
Consent - Board of Chiropractic Examiners - Updated 12/21/10
Consent - State Board of Veterinary Medicine - Updated 12/21/10
Consent - Department of Regulatory Agencies - Updated 12/21/10
UA Collection Site Consent Forms
Any UA Collection Site - Updated 8/25/09
Accu Rapid
Aspen Leaf
Aurora Center for Treatment
BI - Aurora
BI - Denver
BI - Eagle
BI - Frisco
BI - Glenwood Springs
BI - Lakewood
BI - Northglenn
CARS Cortez Addiction Recovery
Choices in Living - Westminster
Choosing Life Center
Delta Drug Testing
Drug Testing Inc - Gunnison
Drug Testing Inc - Montrose
Drug Testing Inc - Telluride
Freedom Choice, LLC
Hubler & O'Connor Counseling
Insight Services
Intervention - Aurora
Intervention - Boulder
Intervention - Brighton
Intervention - Centennial
Intervention - Ft. Morgan
Intervention - Golden
Intervention - Grand Junction
Intervention - Greeley
Intervention - ICCS - Lakewood
Intervention - Longmont
Intervention - Pueblo
Intervention - Sterling
Intervention - Westminster
Larimer County Community Corrections
MCC Drug and Alcohol Screening
Men & Women Seeking Empowerment
Monarch Counseling
OnSite Medical Testing - Greenwood Village
OnSite Medical Testing - Parker
Pagosa Recovery Center
Partnership for Progress
Peaceful Spirits
Recovery Abuse Program - Estes Park
Recovery Abuse Program - Johnstown
Roaring Fork Counseling
Rocky Mountain Behavioral Health - Cañon City
Rocky Mountain Behavioral Health - Salida
San Luis Valley Community Corrections
The Right Door
Turning Point
Wiz-Quiz - Arvada
Wiz-Quiz - Aurora
Wiz-Quiz - Centennial/Aurora
Wiz-Quiz - Evergreen
Wiz-Quiz - Grand Junction
Wiz-Quiz - Northglenn
Yuma County Courthouse - 13th Judicial District