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  • 319-853-8762
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Menu
  • Home
  • About Us
    • Therapists
    • Support Staff
    • Insurance & Fees
  • Locations
    • North Liberty Location
    • Cedar Rapids Location
  • Services
    • Anxiety
    • Child & Adolescent
    • Couples
    • Depression
    • Grief & Loss
    • Trauma & PTSD
    • Medication Management
  • Contact Us
  • Scheduling
  • Paperwork
    • Intake Paperwork
    • Psychiatry Intake Form
    • Couples Paperwork
    • Child & Adolescent Paperwork
    • Good Faith Estimate
    • Cancellation Agreement
    • Release of Information
    • Measures
    • Trauma Measure
Evergreen Therapy Logo: Counseling Cedar Rapids and North Liberty
  • Home
  • About Us
    • Therapists
    • Support Staff
    • Insurance & Fees
  • Locations
    • North Liberty Location
    • Cedar Rapids Location
  • Services
    • Anxiety
    • Child & Adolescent
    • Couples
    • Depression
    • Grief & Loss
    • Trauma & PTSD
    • Medication Management
  • Contact Us
  • Scheduling
  • Paperwork
    • Intake Paperwork
    • Psychiatry Intake Form
    • Couples Paperwork
    • Child & Adolescent Paperwork
    • Good Faith Estimate
    • Cancellation Agreement
    • Release of Information
    • Measures
    • Trauma Measure
Menu
  • Home
  • About Us
    • Therapists
    • Support Staff
    • Insurance & Fees
  • Locations
    • North Liberty Location
    • Cedar Rapids Location
  • Services
    • Anxiety
    • Child & Adolescent
    • Couples
    • Depression
    • Grief & Loss
    • Trauma & PTSD
    • Medication Management
  • Contact Us
  • Scheduling
  • Paperwork
    • Intake Paperwork
    • Psychiatry Intake Form
    • Couples Paperwork
    • Child & Adolescent Paperwork
    • Good Faith Estimate
    • Cancellation Agreement
    • Release of Information
    • Measures
    • Trauma Measure
  • 319-853-8762

Child & Adolescent Paperwork

Parent/Guardian Intake
Parent/Guardian Consent for Psychotherapy
Adolescent Intake Paperwork

This form is for your child who is 14 and older. Do not complete if under 14 years old.

Adolescent Contract for Psychotherapy

This form is for your child to look over (only for children 14 and older). This is a form about privacy and what we share with parents. Your child signs this. Do not give this to children who are younger than 14 years old.

Evergreen Therapy Center

Evergreen Therapy Logo: Counseling Cedar Rapids and North Liberty
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Contact Information

  • 319-853-8762

scheduling@evergreentherapycenter.com

North Liberty Counseling and Therapy
595 Ashley Court, Ste 5
North Liberty, IA 52317

Cedar Rapids Counseling and Therapy
375 Collins Road N.E., Ste 103
Cedar Rapids, Iowa 52402

Hours of Operation

Monday 9AM – 5PM
Tuesday 9AM – 5PM
Wednesday 9AM – 5PM
Thursday 9AM – 5PM
Friday 9AM – 5PM

© All rights reserved

Evergreen Therapy Center