Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Adult Intake Form

Minor/Child Intake Form

Office Policies

HIPPA Notice Of Privacy Practices

Acknowledgment Of Document Receipt

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

 

Contact Today



2412 Waterloo Road
Cedar Falls, IA 50613

office@conditt.org
(319) 277-1020

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.