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Referral for Assessment

Wellness Court & AIIM Program

Please be sure to fill out all * required fields: Referral Type, Client Name, Client Phone, Date of Birth, Client location at the time of referral, Release Form upload

If needed, please fax all referrals to 970-498-7490.

Please download, complete and bring in this AIIM Pre-Screen Release of Information document.

Please download, complete and bring in this Wellness Pre-Screen Release of Information document.

(ex: jail, address, treatment)
*Required - Release Form upload: Download the Release form, fill out, scan and save it to your PC. Then click the Choose File button below, select the filled-out file.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
Attach Document(s)?
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Referrals and documents may also be faxed to 970-498-7490

Please complete the Wellness Court Release for ALL referrals for both AIIM and Wellness Court. At this time all referrals are going through the same screening process. Please submit the release and referral by clicking the green Submit button above, or fax them to (970) 498-7490. You may also email them to Dianne Bacorn at 970-498-7581 (bacorndm@co.larimer.co.us) or Jim Fox (970) 498-7557 (foxjl@co.larimer.co.us)..

If you have any questions regarding the referral process, please contact Dianne Bacorn at 970-498-7581 (bacorndm@co.larimer.co.us) or Jim Fox (970) 498-7557 (foxjl@co.larimer.co.us).