RMCP Hospital follow up enrollment form

Welcome to Follow Up Services with Rocky Mountain Crisis Partners

We offer supportive phone contact at least once a week for at least a month.  Our goal is to provide ongoing support to you and assist with providing referrals and resources as needed.  We want to make sure that you are set up for success after you leave the hospital so that you do not need to return to the hospital for a mental health concern.  

The contact form below will enroll you into the RMCP Follow Up program free of charge.

Note:  RMCP is a HIPAA Compliant organization.  This form and transimission of the submitted information has been secured in accordance with HIPAA compliance and security standards.

For Hospital Staff to Fill Out
XXX-XXX-XXXX
For Participant to Fill Out
MM/DD/YYYY
XXX-XXX-XXXX
  • Yes
  • No
  • Yes
  • No
  • Yes
  • No