Welcome to Elliant!

Client Forms

Thank you for being here. We're excited to support your goals!

This page is for new clients who have already had a consult with their therapist and are ready for the next step. Haven’t had a consult? Contact us to set up a free confidential consult.

To complete the on-boarding process, please complete our four (4) digital intake forms. Please note that we are legally required to have these forms on file before you can receive services.

Directions:

1. First, an easy one: Please submit your credit card payment information to be put on file. Your card information will not be stored by ECS. All payments are processed securely through Square.
Credit Card Payment Information Form

2. Next up: Please fill out the credit card authorization form, which allows ECS to submit future billing on your card through Square (so you only have to submit your payment info once).
Credit Card Authorization Form

3. Now the legal stuff: Please read and sign the Disclosure Statement for the therapist you’ll be seeing, making sure to select the appropriate disclosure (for Individual Adult, Couple/Family, or Minor for anyone under 18 years of age):

4. OK, just one more! The Welcome Packet contains a series of questions that will help your therapist learn more about you and why you’re seeking therapy before your first session. It also contains important information about our office policies, non-discrimination practices, confidentiality, and consent.

Please choose your therapist and the relevant welcome packet to fill out, sign, and submit:

5. That’s it! Please see our contact page for our address and a map to our office. When you arrive you’ll note that our lobby is unattended. Find your therapist’s nameplate on the wall next to a button. Turn the button “on” to alert them that you have arrived.

Please let us know if you have any other questions or concerns. We’re here to help!

Good Faith Estimates

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the Colorado Division of Insurance at 303-894-7490 or 1-800-930-3745.