Patient Health Questionnaire-9 (Phq-9) Template/form Gad-7 Page 3
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8Neal Brugman, Psy.D.
(720) 295-7605
Disclosure and Informed Consent
Service Provider:
Neal Brugman, Psy.D. – Licensed Clinical Psychologist, Colorado license #3786
Education/Degrees:
Doctor of Psychology – Clinical Psychology
University of Denver, Graduate School of Professional Psychology, 2011
Master of Arts – Clinical Psychology
University of Denver, Graduate School of Professional Psychology, 2008
Bachelor of Arts – English Literature
University of Dallas, 2002
Division of Registrations:
The Colorado Mental Health Licensing Section of the Division of Registrations has the
general responsibility of regulating the practice psychotherapy. As to the regulatory
requirements applicable to mental health professionals:
A Licensed Psychologist must hold a doctorate degree in psychology and have 1500 hours of post-
doctoral supervision (Please note this is Dr. Brugman’s level of training). A Psychologist Candidate, a
Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must
hold the necessary licensing degree and be in the process of completing the required supervision for
licensure. A Licensed Clinical Social Worker, a Licensed Marriage and Family Therapist, and a
Licensed Professional Counselor must hold a masters degree in their profession and have two years
of post-masters supervision. A Licensed Social Worker must hold a masters degree in social work. A
Certified Addiction Counselor I (CAC I) must be a high school graduate, and complete required
training hours and 1000 hours of supervised experience. A CAC II must complete additional required
training hours and 2,000 hours of supervised experience. A CAC III must have a bachelor’s degree in
behavioral health, and complete additional required training hours and 2,000 hours of supervised
experience. A Licensed Addiction Counselor must have a clinical masters degree and meet the CAC III
requirements. A Registered Psychotherapist is registered with the State Board of Registered
Psychotherapists, is not licensed or certified, and no degree, training or experience is required.
Contact Information
The Board of Psychology Examiners
1560 Broadway, Suite 1350
Denver, Colorado 80202
303-894-7800
Client Rights and Important Information:
As a client seeking mental health services, you have certain rights. These include your right
to seek a second opinion from another therapist or your right to terminate this therapy at
any time. You are also entitled to receive information regarding the methods of therapy,
techniques used, the duration of therapy (if known), and the fees. Please ask if you would
like to receive this information.
In a professional relationship (such as ours) sexual intimacy between a therapist and client
is never appropriate. Any circumstances of sexual intimacy within a therapeutic
relationship should be reported to the Board of Psychology Examiners listed above.
Generally speaking, the information provided by and to a client during therapy sessions is
legally confidential if the therapist is a licensed psychologist, licensed social worker,
The Collaborative Center, LLC
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