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Therapy Inquiries

Neuro Colorado is merging with Braincode Centers to provide you with better care and options going forward. Use the form below to contact Neuro Colorado/Braincode Centers. We will get back to you within 12 hours.

address

1720 S. Bellaire Street
Suite #710
Denver, CO 80222

contact

Phone: 720-232-0834
Fax: 720-325-2399

*Indicates Required Field

First Name*

Last Name*

Email Address*

Phone Number*

May we leave a message?*

Yes

What is your preferred method of contact for scheduling?*

Phone

Who are you contacting us about?*

Myself

A minor child

An adult dependent

Other (please specify below)

Who are you contacting us about: Other (if applies)

Primary client name
If you are filling this form out for someone else, please include their name here.

What is your relationship to the primary client?
Note that we cannot contact a person who is not you or a minor who is your legal dependent.

Myself

My Child

My Partner

Other (please specify below)

What is your relationship to the primary client: Other (if applies)

What kind of therapy are you seeking?*
Please choose all that apply.

Adult Individual Therapy/Counseling

Adolescent Individual Therapy/Counseling

Child Individual Therapy/Counseling

Adult Neurotherapy (Neurofeedback)

Adolescent Neurotherapy

Child Neurotherapy

Neurofeedback Mentoring/Training

Do you know which counselor you’d like to see?
‍Get to know our counselors here.
(If the therapist you choose is not accepting new clients, we’ll help you get connected with another provider.)

Please let us know what you’d like to work on in a few sentences.
You can reference the list below if it’s helpful to you.
Example Topics List:

Academics/Work/Career
Addiction
ADHD
Adolescent Concerns
Anger
Anxiety and Worry
Art Therapy
Attachment
Body Image
Childhood Relationship Trauma
Codependency
Cognitive Behavioral Therapy (CBT)
Coming Out
Couples Counseling
Cultural Issues
Depression or Low Mood
Divorce Recovery
Eating Disorder
Exercise
Eye Movement Desensitization and Reprocessing (EMDR)
Faith Deconstruction
Family Conflict
Food Concerns
Grief and Loss
High Sensitivity
Internal Family Systems (IFS)
LGBTQIA
Low Self-Esteem
Men’s Issues
Mild Traumatic Brain Injuries
Military
OCD
Parenting Support
Postpartum (New Mom)
Relationships
Resilience
Self-Compassion
Sensory Processing
Sexuality
Shame
Somatic Experiencing
Spiritual Abuse/Cult
Spirituality
Stress
Substance Use
Trauma (Adult Onset)
Trauma (Childhood)
Women’s Issues

Do you have specific scheduling needs?

I have a flexible schedule.

I prefer certain appointment times (please specify below).

Please select as many as possible to help with scheduling:

Weekday Mornings

Weekday Lunches

Weekday Afternoons

Weekday Evenings

What are your payment preferences? (Please choose all that apply.)

I plan to pay privately.

I would like a superbill for counseling services to request reimbursement through my provider.

How did you hear about our practice?

Web Search

Current Healthcare Provider (doctor, psychiatrist - please specify below.)

Friend or Acquaintance

Current Client

Psychology Today

Other (please specify below)

How did you hear about our practice: Other (if applies)

Current Healthcare Provider (if you marked the option above)

Is there anything else you'd like us to know at this time?

We've received your message and will get back to you shortly. In the meantime, feel free to schedule an appointment with us:

Oops! Something went wrong while submitting the form.

*Indicates Required Field

First Name*

Last Name*

Email Address*

Phone Number*

May we leave a message?*

Yes

How did you hear about our practice?

Web Search

Current Healthcare Provider (doctor, psychiatrist, etc.)

Friend or Acquaintance

Current Client

Psychology Today

Other (please specify below)

How did you hear about our practice: Other (if applies)

Is there anything else you'd like us to know at this time?

We've received your message and will get back to you shortly. In the meantime, feel free to schedule an appointment with us:

Oops! Something went wrong while submitting the form.

1720 S. BELLAIRE ST. #710
DENVER, CO 80222
P: 720-232-0834
F: 720-325-2399

Licensed in Colorado.

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