If you are new to Cedar Rapids Counseling and Psychotherapy, you will need to read and complete some forms before arriving for your first session. These forms will take some time to complete, usually about 20 minutes. Each therapist has her own set of forms. These forms are also available on each therapist's personal page.
If you have an appointment scheduled with me: please read "Introduction to Alex" (located below) as it contains important information about location, parking, insurance, payment, and the necessary paperwork to get started with your therapy.
Introduction to Alex
Agreement for Services
Client Information Form
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information: Release Form
New clients must first schedule an appointment by phone with Penny. Please do not complete the paperwork until we have scheduled an initial appointment.
There are three options for completing the forms that are required for our first session.
1. You may request that I mail you the paperwork. You can then complete it in handwritten form and bring it to your first appointment.
2. You may print the following forms, complete them in handwritten form and bring them to your first appointment. New Client Packet
3. You may complete and submit the information electronically. If you choose this method, please visit TherapyAppointment.com. Clicking on this link will take you to my portal. There you will see the tab “Register as a new patient/client” that you will click on. You may then establish a username and password and complete the required information electronically. Please print, review, and sign the Agreement for Services form prior to the first session.
Scheduling on-line: If you choose to use TherapyAppointment, you may wish to schedule additional appointments through the online portal. This feature is not available to schedule a first-time appointment.
Couples or marital counseling: please designate one partner to complete the paperwork as directed above. Both partners need to read the Agreement for Services and initial and sign the Signature Page. Please print out a copy of the Medical and Social History form for the second partner to complete. Medical and Social History Form.
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information: Release of Information
Note: To download Adobe Acrobat Reader for free, click here.
Information about using the online portal @ TherapyAppointment.com: Therapyappointment.com is as cloud-based system that stores Personal Health Information (PHI) and thus is responsible for adhering to the laws of HIPAA and HITECH. It complies with all HIPAA regulations that include but are not limited to: encrypted transmission of internet communication containing PHI/ passwords and credit card information; certain aspects of patient information are encrypted within the database; the system is scanned regularly for HIPAA compliance; the server is maintained in a Level 3 security compliant facility; login attempts are monitored; and TherapyAppointment staff has completed HIPAA training. The best technical security can be defeated, particularly if you do not protect your user ID and password to access the portal. If you believe that these security measures have been compromised, immediately change your password and report the matter to CRCPG’s HIPAA Security Officers, Alexandria Carey or Penny Freeman, at 319-362-0632.