We look forward to working with you.  Feel free to contact us with any questions or to schedule an appointment.  Simply complete the form below or call (720) 445-5992.  Please rest assured that any information submitted via our website or on our voicemail is extremely confidential. We look forward to hearing from you and will be in touch shortly.

What is your relation to the potential client? (required)

If you are not the potential client, what is that person's name?

How old is the potential client?

If you would like to schedule an appointment, please let us know what date and time you would prefer:

at (Optional)

*Dates and times are not guaranteed. We will contact you prior to your appointment to confirm a time.

Please check the box, confirming the following:

By checking this box, I understand that this information will be sent to Momentum Mental Health securely, and be reviewed by a licensed mental health provider. I understand that in some cases, the details regarding the mental health of a family member may be protected by United States federal law and not able to be discussed with anyone but the client, without consent -- regardless of my relationship with the client. I give permission for a mental health provider to contact me, by any of the methods provided above.

I understand and agree to the statements above.