Brain Injury Alliance of Colorado

Client Intake Form

If you’re interested in learning more about BIAC services and how we can support survivors of all types of brain injury all around the state, please fill out this form. We will get back to you to talk more about our programs and services as soon as we can.

Note – This is not an application for case management services. If you are interested in applying for case management and would like to bypass this initial referral form, please click here for the application.  

To read more about what the case management program offers, click here