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:
Fill out the Disclosure Form for your individual provider by selecting their name below. Clicking the link accesses the form at hellosign.com. You will be asked to enter an email address where the form will be sent with instructions to complete it.
Using the same process, fill out your payment information. Your card information will not be stored by ECS. All payments are processed securely through Square.
Next up, fill out the authorization form, which allows ECS to submit future billing on your card through Square so you only have to submit your payment info once.
OK, just one more! Choose the relevant welcome packet and submit it.
Welcome Packet & Consent for Minors (under 12 years of age)
That’s it! We look forward to seeing you soon. Welcome to Elliant!
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.