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
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First Name
Last Name
Phone Number
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Email
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example@example.com
Date of Birth
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Month
-
Day
Year
Date
Gender
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Please Select
Female
Male
N/A
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
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Please Select
I will pay for therapy myself
Aetna
Anthem Blue Cross Blue Shield (PPO)
Blue Cross, Blue Shield
Boulder County Victims Compensation
Jefferson County Victims Compensation
Colorado Access Medicaid
Health First
Kaiser Permanente
Rocky Mountain Health Plans Medicaid
United Healthcare
Out-of-Network (Superbill for reimbursement)
Other-Please make sure to note which one
Policy No
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Group No
Photo of insurance card (Front)
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Photo of insurance card (Back)
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Subscriber's Name if different than Client (ie Parent, Child or Spouse)
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Subscriber's Relationship to Patient
If there is a specific therapist you would like to work with, please let us know:
Please Select
Brynn Miller Hakon
Linna Shih
Joe Reid
Amy Porter
Margarita Mironova
Christine Mangum
Andrew O'Reilly
Sydney Leto
Monica Posada
Leda Swann
Jessie Westbrook
Eve Beilovei
Waynette Brittingham
Sharlene Vanderblock
Anna Hallinan
Aaron Grobler
Laine Smith
Dr. Noah Goldstein (acupuncture, private pay)
If they have availability, we will do our best to schedule you!
Please provide days and times you are available to see your therapist:
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Main Area of Concern:
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What kind of therapy are you seeking?
Please Select
Individual Therapy
Couples Therapy
Family Therapy
Group Therapy
Child/Adolescent Therapy
Main Mode of Therapy
Please Select
Talk Therapy: Traditional therapy involving conversation with a therapist.
Psychoanalysis: Explores unconscious thoughts influencing behavior.
EMDR: Eye movements used to process trauma and distressing memories.
Brainspotting: Targets trauma by identifying specific eye positions linked to emotional pain.
ERP: Gradual exposure to anxiety triggers, often used for OCD.
CBT: Focuses on changing negative thoughts and behaviors.
DBT: Combines cognitive therapy with mindfulness for emotional regulation.
IFS: Addresses different parts of the self to heal internal conflicts.
ACT: Focuses on accepting thoughts and feelings while committing to values-based actions.
Art Therapy: Uses creative expression to explore emotions.
Play Therapy: Helps children communicate feelings through play.
Somatic Psychotherapy: Integrates body awareness in therapy.
Mindfulness-Based Therapy: Uses mindfulness to reduce stress and improve focus.
Ketamine Assisted Therapy: Combines therapy with ketamine to treat depression or PTSD.
Acupuncture: Holistic approach using traditional Chinese medicine.
Support for Substance Use: Therapy aimed at managing addiction.
Grief Counseling: Support for processing loss and grief.
LGBTQIA+ Affirming Therapy: Supportive therapy focusing on LGBTQIA+ concerns.
Crisis Intervention: Immediate support for acute mental health crises.
Trauma-informed Approach: Therapy grounded in understanding the impact of trauma.
Notes that may be relevant to the verification process and a brief overview of what you are looking for support with.
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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?
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.
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