Become a client

Become a client

Welcome to Thrive! Please complete this form to take the first step in working with a therapist at Thrive. This information will help us verify your insurance or discuss payment options. We will follow up in the next couple of days, once the verification is complete. Thank you for your patience!
Personal Information

All information is kept private and confidential and only used by Thrive to support you working with the right therapist for your care.
Name of Client

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address Information

Please provide your address so we can contact you and review your insurance or payment details.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
We request gender information solely for insurance verification purposes. At Thrive, we fully support and affirm all gender identities and expressions. Please provide the information that matches your insurance records.
Insurance Information

If you don’t see your insurance company listed, we don’t currently accept your insurance. We can still help you find a licensed therapist if you can pay for therapy yourself (some plans will reimburse you for the sessions). We are not able to take Medicare, CIGNA or HMO's at this time. Thank you for understanding
Primary Insurance Co
Policy No
Group No
Photo of insurance card (Front)

Cancelof
Photo of insurance card (Back)

Cancelof
Subscriber's Name if different than Client (ie Parent, Child or Spouse)

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Subscriber's Relationship to Patient
Subscriber Number
If there is a specific therapist you would like to work with, please let us know:
If they have availability, we will do our best to schedule you!
Please provide days and times you are available to see your therapist:
Main Area of Concern:
What kind of therapy are you seeking?
Main Mode of Therapy
Notes that may be relevant to the verification process and a brief overview of what you are looking for support with.
If your inquiry is urgent, please send a direct email to support@boulderthrive.com. Please note that every inquiry is read by a real person and addressed with urgency!
How did you hear about us?
Name of person filling in form if different from the client application:

First NameLast Name
By providing your consent, you agree to receive text (SMS) messages and emails from Thrive at the contact information provided. We are committed to keeping all your information private and confidential, in compliance with HIPAA regulations. You acknowledge that you understand the risks associated with electronic communication and agree to participate in these services for appointment reminders, scheduling, and other relevant communication.
Should be Empty:

Become a client

Personal Information

Address Information

Insurance Information