Accepting Medicaid Patients

In Network for Colorado Access Medicaid

CCHA Medicaid starting Aug 15, 2025

Self Pay please complete a request form below as well if you plan on using an HSA or Credit Card for payment.

Name

First Name

Last Name

Phone (optional)

By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Appointment Type

Medicaid type and ID Number

Specify whether Colorado Access or CCHA

Message

Intake appointments are scheduled Monday afternoons, or Tuesday through Thursday from 8am to 6pm MST. Please specify a preferred day or time or next available.

Patients who do not have commercial insurance or do not qualify for CO Medicaid, can be evaluated for a income based sliding scale on an individual basis.