Get Co Approved Treatment Provider Program Enrollment Request 2006

The CO Approved Treatment Provider Program Enrollment Request is an essential document for agencies seeking approval to provide treatment services within the Colorado Department of Corrections. This guide offers detailed, step-by-step instructions on how to successfully fill out the form online, ensuring clarity and ease of understanding for all users.

Follow the steps to complete your enrollment request online.

1. Click ‘Get Form’ button to obtain the form and open it in your opt-in editor.
2. Begin by entering your agency name and type of agency, selecting from options such as corporation, individual, or proprietor.
3. Fill in the agency's address and primary contact phone number.
4. Provide your financial identification number or social security number.
5. List the clinicians involved in the treatment program. For each clinician, include their name, social security number, date of birth, degree, and license number. If a clinician is not licensed, provide additional details regarding their supervision.
6. Review the treatments and services offered. Check all relevant treatment programs, evaluations, and services for which you are applying.
7. List three professional references who are not related to you. Include their names, phone numbers, agency, and addresses.
8. Submit additional required documents with your application, including a description of your organization, experience details, treatment program overview, fee schedules, proof of liability insurance, and necessary signed forms.
9. Ensure all information is complete to avoid delays in processing your application.
10. Once all sections are properly filled out, you can save your changes, download the form, print it, or share it as needed.

Complete your CO Approved Treatment Provider Program Enrollment Request online today!