The Epilepsy Foundation of Colorado and Wyoming offers up to 80% reimbursement for mental health services. Reimbursement is only provided to those in our service area (Colorado/Wyoming). This form is a pre-approval to let you know if you would qualify for reimbursement.
Along with your approval, you will receive access to a reimbursement instructions and a list of therapists that are members of our Preferred Provider Network, you DO NOT have to see a Preferred Provider to receive reimbursement.
Approval is valid until the last day of the calendar year. You can reapply each year for reimbursement.
When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.