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

Employment Opportunities


For a digital format of our paperwork to fill out and send back electronically please email

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