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- Grinnell Iowa Counselors and Other Mental Health Providers
- Williamsburg Iowa Counselors and Other Mental Health Providers
Online Payments
Phone Our Iowa Locations:
- Grinnell 6412361644
- Williamsburg 3196681217

Services
Methods
Forms
Team
- Grinnell Iowa Counselors and Other Mental Health Providers
- Williamsburg Iowa Counselors and Other Mental Health Providers
Online Payments
Phone Our Iowa Locations:
- Grinnell 6412361644
- Williamsburg 3196681217

Forms

NOTE: After you have made your initial appointment, please complete the appropriate online forms by clicking the links below:

Client Registration Form

Telehealth Disclosure Form

Release Of Information Consent Form

Credit Card Recurring Payment Authorization Form

Patient Communication Consent Form

Secure Document Upload

Adult Biopsychosocial History Form

Child Biopsychosocial History Form

Client Assessment PHQ-9 Form

Client Assessment Gad 7 Form

Geriatric Depression Scale (GDS)

Post Traumatic Stress Disorder PCL-5

CONTACT US

Please note all information submitted via this contact form is kept confidential. However, please note that this is not a secure email transmission. In accordance with The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act), “Personal Health Information” may not be included in this transmission. Thank you for your cooperation.

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Contact Us

Grinnell counselors

Midwest Counseling
818 4th Avenue
Grinnell, Iowa 50112

Phone: 6412361644
Fax 844-361-1220

Williamsburg counselors

Midwest Counseling
306 W State St., PO Box 313
Williamsburg, Iowa 52361

Phone: 3196681217
Fax 319-668-1220

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