Andrew E. Leifer, M.D., P.C
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    • 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  
​Office Policy 
Patient Intake Form 

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

If you are a patient having another person pay for your appointment, the responsible payer must fill out the following form and the patient must fill out a Release of Information form (above) for the payer:

Alternate Payer Form  

If you will be seeing Dr. Leifer via Teleconference, please complete the following form:
Telehealth Informed Consent

If you are a Medicare subscriber, please complete the following form:
Medicare Private Contract Form
​

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