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PROFESSIONAL
MENTAL
HEALTH
COUNSELING

Q

The very first thing you should do is to visit the Staff page and decide which therapist you wish to see.

If you are new to this practice or have not been seen by your therapist for a year or
more, please select Form "A" above - fill out all the information requested and then
press the "Submit" button at the bottom.  Then do the same with Form "B".

The History (see above) and the HIPPA (also above) need only be completed the first
time you come in...or if it's been more than a year since you first came in.
Print these forms on your home printer, fill them out and bring them with you when you come for your first appointment. Also bring along your insurance card, your drivers license and your co-pay amount.   If you have questions, please feel free to call.

2028 E. 38th St.  Ste. 3    Davenport, Iowa    52807