Andrew E. Leifer, M.D., P.C
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    • Our Staff
    • New Patient Intro
    • Group Treatment
  • Forms
    • New Patient Forms
    • Suboxone and Substance Use Disorder Forms
    • Existing Patient Charting Forms
    • Document Submission Form
    • COVID-19 In Person Office Visit Form
  • Patient Education
    • Education
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  • Contact
  • Coronavirus
    • Telehealth Informed Consent Form
  • Medicare Private Contract Form
After speaking with our office staff at 303-674-6074, please submit the following forms to confirm your initial appointment:  
Personal Information Online Submit  
​Office Policy Online Submit 
Patient Intake Form Online Submit 
Alternate Payer Online Submit  (Complete this form when a person other than the patient is the responsible payer)

Release of Information Online Submit​  (Submit for any provider, family member, etc. you wish Dr. Leifer to  communicate with)

NEW FOR TELECONFERENCE APPOINTMENTS:
Telehealth Informed Consent Online Submit


MEDICARE PATIENTS:
Medicare Private Contract Form
​
If you did not submit the above forms online, please print, complete the following forms within 72 hours of scheduling your initial appointment and fax to 303-831-9601 or mail to Andrew Leifer MD, 1202 Bergen Pkwy Ste 211, Evergreen CO 80439.
Personal Information Form
Office Policy Form

Patient Intake Form
Release of Information Form ​(Complete for any provider, family member, etc. you wish Dr. Leifer to communicate with)
Alternate Payer Form (Complete this form when a person other than the patient is the responsible payer)

Additional information about your first appointment may be found on our New Patient Introduction page.



This site is for information only and is not intended as a substitution for psychiatric treatment.

ANDREW LEIFER M.D., P.C.  2015
303-674-6074