Central Iowa Psychological Services

Making An Appointment - Ames

To make an appointment with any of our therapists in our Ames Office, please call 515-233-1122 and talk with a receptionist. Then download the following forms, print them off, fill them out and bring them with you or we will mail them to you if you prefer. Our receptionists will want to know some details about what your concerns or problems might be and will need the information on your insurance card if you will be using insurance to pay for our services. We take cash, checks, Mastercard, VISA, Discover and American Express as forms of payment for services or insurance co-pays. Payments are due at time of service. For more information about our services please see our FAQ page.

In accordance with federal guidelines Central Iowa Psychological Services complies with all HIPAA regulations. Please see the privacy notice below.

If you have any trouble downloading these forms, visit the Adobe website to download the free Acrobat Reader or call the office and we will assist you.

Please bring your completed forms with you to your appointment or arrive at least a half hour early to complete these documents for your therapist.

Forms for Child Clients

1. Privacy Notice (1 page pdf)

2. HIPAA Consent and Agreement Form (4 page pdf)

3. Patient Bill of Rights (1 page pdf)

4. Child History Form

5. Credit Card Payment Information

Forms for Adolescent Clients

1. Privacy Notice (1 page pdf)

2. HIPAA Consent and Agreement Form (4 page pdf)

3. Patient Bill of Rights (1 page pdf)

4. Child History Form

5. Adolescent and Adult Symptom Checklist

6. Credit Card Payment Information

Forms for Adult Clients

1. Privacy Notice (1 page pdf)

2. HIPAA Consent and Agreement Form (4 page pdf)

3. Patient Bill of Rights (1 page pdf)

4. Adult Intake Form (5 page pdf)

5. Adolescent and Adult Symptom Checklist

6. Credit Card Payment Information

For more information or to arrange an appointment, please contact us:
Central Iowa Psychological Services