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  • About Us
    • Therapists
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    • Insurance & Fees
  • Services
    • Anxiety
    • Child & Adolescent
    • Couples
    • Depression
    • Grief & Loss
    • Trauma & PTSD
  • Paperwork
    • Intake Paperwork
    • Couples Paperwork
    • Child & Adolescent Paperwork
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    • Release of Information
    • Measures
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  • Home
  • About Us
    • Therapists
    • Support Staff
    • Insurance & Fees
  • Services
    • Anxiety
    • Child & Adolescent
    • Couples
    • Depression
    • Grief & Loss
    • Trauma & PTSD
  • Paperwork
    • Intake Paperwork
    • Couples Paperwork
    • Child & Adolescent Paperwork
    • Good Faith Estimate
    • Cancellation Agreement
    • Release of Information
    • Measures
  • Contact Us
  • Scheduling
Menu
  • Home
  • About Us
    • Therapists
    • Support Staff
    • Insurance & Fees
  • Services
    • Anxiety
    • Child & Adolescent
    • Couples
    • Depression
    • Grief & Loss
    • Trauma & PTSD
  • Paperwork
    • Intake Paperwork
    • Couples Paperwork
    • Child & Adolescent Paperwork
    • Good Faith Estimate
    • Cancellation Agreement
    • Release of Information
    • Measures
  • Contact Us
  • Scheduling
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  • 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

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Services

  • Anxiety
  • Panic
  • Trauma
  • Depression
  • Fees

Hours of Operation

Monday 8AM – 6PM
Tuesday 8AM – 6PM
Wednesday 8AM – 6PM
Thursday 8AM – 6PM
Friday 8AM – 5PM

Contact Info

Evergreen Therapy Center
595 Ashley Court Ste 5
North Liberty, IA 52317-0800
(319) 853-8762

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Evergreen Therapy Center