UOAP Administration Center for Marula Rehab

Registraton and Assessment Center

If you have not registered for Marula Services yet, please Start Here

If you have completed your initial registration, please proceed below.

Patient Intake Forms and Documents:

 

Marula Rehab’s Forms and Documents have been prepared to facilitate a seamless patient‐intake process, enabling the expeditious and precise completion of the Initial Registration, the Initial Assessment, and any additional intake documentation requisite for commencing services. Scroll down to find the Intake packages and other forms.

 

Special Accommodations:

 

If you require assistance completing these forms due to a qualifying disability under the Americans with Disabilities Act, please contact our Special Accommodations Coordinator at 385-376-8950. Assistance is available Monday through Friday from 11:00 a.m. to 7:00 p.m. Mountain Standard Time.

IF YOU ARE COMPLETING THESE FORMS FOR ANYONE BUT YOURSELF,  STOP AND  HAVE THE PATIENT CALL OUR OFFICE

NEW REGISTRATION

NEW PATIENT ASSESSMENT FORMS

NEW PATIENT PROBATION AND PAROLE FORMS

NEW PATIENT RISK  ASSESSMENT FORM

NEW PATIENT FINANCIAL ASSISTANCE FORM

NEW PATIENT FINANCIAL ASSISTANCE FORM

HEALTH INSURANCE COVERAGE QUESTONAIRE

IF YOU ARE UNINSURED, PLEASE STILL COMPLLETE THE HEALTH INSURANCE QUESTIONAIRE