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Breakthrough Psychiatry LLC

719-423-0694

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  • Services
  • Contact Us
  • Insurance & Billing
  • Patient Forms
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  • FAQ's
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  • More
    • Home
    • Services
    • Contact Us
    • Insurance & Billing
    • Patient Forms
    • Referrals
    • FAQ's
    • Payment Info
Breakthrough Psychiatry LLC

719-423-0694

  • Home
  • Services
  • Contact Us
  • Insurance & Billing
  • Patient Forms
  • Referrals
  • FAQ's
  • Payment Info

Patient referral forms

Thank you for your interest in referring your patient to Breakthrough Psychiatry LLC. Please click on the links below to access our Patient Referral Form and our Release of Information Form. Please fax completed forms to 719-370-4424.

Patient Referral Form (pdf)

Download

HIPAA Authorization - Release of Health Information (pdf)

Download

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