• 303-393-1594

    info@drsamaniego.com

    Request an Appointment facebook-icon(small) facebook-icon(small)

    • Home
    • Services Provided
    • Rates & Insurance
    • Helpful Forms
    • Workshops
      • Leadership and Life Auditing for High Performance Living
    • Links & Resources
      • Common Questions
      • National – Mental Health Links
      • National – Physical Health Links
    • Buy Books & CD’s
    • Contact Me
    • Appointment Request

    Helpful Forms

    If you’re a new client, please complete the following forms and bring them to your first therapy session.

    • Client Contact Information Sheet
    • Client Intake
    • Limits of Confidentiality

    If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

    • Authorization for Release of Information

    Contact Info

    Lupe-Rebeka Samaniego, PhD
    Clincal Psychologist


    2565 East Alameda Cir
    Denver, CO 80209

    303-393-1594
    info@drsamaniego.com

    Contact Me

      By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

  • 2565 East Alameda Cir   |   Denver, CO 80209   |   303-393-1594

    All Rights Reserved | Dr. Samaniego
  • As Seen On:

    Media Contact Request