Family Counseling & Psychology Center
2485 Tech Drive, Bettendorf, IA. 52722
Phone: 563.355.1611 | Fax: 563.355.6617

Employment Opportunities


If you would like to complete the paperwork digitally please email to have a portal request sent to you.

If you have insurance we ask that you call your insurance company before the appointment and ask:

  • If a pre-authorization is required
  • If you are meeting a deductible
  • The number of visits you are allowed 
  • If you have a copay

Adult Form (Age 18 and Older)

Download Your Adult Form

Child Form (Age 18 and Under)

Download Your Child Form