New Patients

To All New Patients

As with any health care practice, Telehealth requires health insurance, health intake forms and medical records prior to your initial appointment. The advantage is you can complete these forms at your convenience and under the privacy of your home.

Please complete and submit online the digital Health Insurance, Health History and Consent Forms that are located below:

STEP 1

HIPPA Privacy Form
(READ ONLY)

Click Here

STEP 2

Patient Health
Insurance Form

Click Here

STEP 3

Patient Health
Intake Form

Click Here

STEP 4

Telehealth Consent & Financial Responsibility

Click Here

STEP 5

Medical
Release

Click Here

Please note, after Dr. Grandi Nikander reviews the above completed forms and medical records, our Office Administrator Nadine will notify you through email so that you may self-schedule your initial consultation appointment.

Please confirm with your insurance company that Telehealth Services (Telemedicine-
Telepsychiatry) are covered under your individual insurance policy. Otherwise, if not covered by insurance we require online Pre-Payment prior to your Telehealth Appointment. Thank you.

Please click the following button to make your Telehealth Pre-Payment now:

We Accept the following Health Insurance Plans:

Aetna

Anthem Blue Cross Blue Shield

Cigna

GEHA

Medicaid

Medicare

TriCare

United Health Care

United Health Care OPTUM

Donna Grandi Nikander

4450 Arapahoe Ave STE 100
Boulder Colorado 80303
303 444 6800 Telephone
303 496 6802 General Fax
303 848 4842 Medical Records Fax