This form and any associated attachments are confidential. Forms are submitted through a service provided by JotForm (www.jotform.com) and encrypted information is stored on Jotform servers. Continuum of Colorado's HIPPA compliance officer has determined that the manner of form encryption and storage, combined with our organization's privacy practices, allow us to use this service in a HIPPA compliant manner. Details on our privacy practices may be found here. Any person or organization using this form to submit confidential and protected information to us should determine for themselves if doing so poses any risk to their patient information. If so, referrals may also be made by fax, sent to the attention of Behavioral Services Department @ (303) 214-3360. Additionally, referrals can be made by calling our intake coordinator at (303) 214-3367.