Contact Me

Name *

First Name

Last Name

Insurance *

I understand that Keep Going Mental Health is an out-of-network provider for all insurance companies. I also understand that if I am insured under Colorado Medicaid I am unable to be seen through Keep Going Mental Health and will need to seek services from an in-network Medicaid provider.

I understand

Healthcare Communication

I understand that this form is intended as a means of initial contact and does not meet privacy standards for healthcare communications. I have provided my name and email in order for Keep Going Mental Health to make contact with me. Any additional information I have chosen to include in the “message” section was done so with the understanding that I have not yet entered into a healthcare relationship with Keep Going Mental Health.

I understand