Quick Admit Form

Refer a Patient

Thank you for considering ACUTE Center for Eating Disorders & Severe Malnutrition as a treatment resource for your patient requiring a higher level of eating disorder care.

Patient Information

First Name

Last Name

Date of Birth

Enter date in the YYYY-MM-DD fomat.

Phone

Race

Relationship status

Disabilities

Religion/Spiritual Orientation

Employment status

Yes

Unsure

Highest Education

Military service

Yes

Unsure

Guardian Information

First Name

Last Name

Phone

Relationship to Patient

Insurance Information

Name of Insurer

Insurance Contact Phone

ID/Account Number

Group Number/Account Number

Name of Policy Holder

Relationship to Patient

Policyholder Date of Birth

Enter date in the YYYY-MM-DD fomat.

Name of Employer

Treatment Team Information

Therapist Name

Dietitian

Psychiatrist

Primary Care Physician

Provider Assessment

Height

Weight

Diagnosis

Diagnosis Notes

Treatment History

Other Medical Issues

Current Medications

Known Food Allergies

Known Medication Allergies

Patient Strengths

Preliminary Treatment Goals

Submitting Provider Information

First Name

Last Name

Phone

Employer/Organization

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.