A non-profit mental health agency Waterloo Counseling Center honoring cultural and human diversity
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Information for First Appointment

Please bring to the first appointment the following information:

  • Proof of identification
  • Proof of income (if paying less than $95)

Please complete and bring to the first appointment the following forms:

  • Medical Information Form (see right)
  • Therapist-Client Agreement (see right)
  • HIPAA Agreement (see right)

Please arrive 10 minutes before your appointment.

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Forms and Fees

Medical Information Form: Download

Therapist-Client Agreement: Download

HIPAA Agreement: Download

Sliding Scale Fees: Download

Adult Wellness Assessment Form: Download

Note: Adobe Acrobat Reader is needed to view these documents. Click below for free download:

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