Thank you for trusting La Cocina's clinical team with your referral. We proudly serve the entire state of Colorado, and your completed form helps us connect with you quickly and effectively. If you are completing this form during regular office hours, one of our clinicians will contact you within 48-business hours.  If you have any questions or need assistance completing this form, don’t hesitate to call us at 970-232-0740.  We’re here to help and look forward to connecting with you.