Fall 2026: Now Accepting New Clients - Call (319) 804-9312
Most clients don't need the forms on this page.
When your first appointment is scheduled, our intake coordinator sends you a link to our Client Portal, where you can complete and sign everything online. That is the fastest way to get started and it is what we recommend.
The forms below are for clients who would rather use paper. If you would prefer not to use the portal, just tell your intake coordinator and we will arrange to have you fill out paper copies.
New Patient Information with Parent or Guardian
Información de Pacientes (Adultos)
Consentimiento del Tutor Legal para el Tratamiento
Políticas de la Oficina y Formulario de Consentimiento
Política de Comunicaciones con el Paciente
Consentimiento Informado para Servicios de Salud Telemental
Acuerdo Financiero para la Salud Telemental
ROI Autorización para la Divulgación de Información Protegida
Note: These are print-and-sign PDFs. Please print the form, complete it by hand, and sign it with a pen. We can't accept these particular PDFs filled in on a computer, because we have no way to verify a typed signature. If you'd like to complete and sign electronically, use the Client Portal instead. It's built for exactly that.
HIPAA Notice of Privacy Practices
Notice for the No Surprises Act: You have the right to receive a good faith estimate of expected charges.
Your provider may ask you to complete one or more of these. The easiest way is through the Client Portal, where your answers go directly into your record. If your provider gave you a paper copy, bring it to your next appointment or hand it to our front desk. Please do not email completed forms to us. Regular email is not secure, and these forms ask about personal health information.
PHQ-9: Patient Health Questionnaire
GAD-7: Generalized Anxiety Disorder Screener
ASRS: Adult ADHD Self-Report Scale Symptom Checklist