Making an Appointment – Ankeny
To make an appointment with any of our therapists in our Ankeny Office, located at 215 NW 18th Street in Ankeny, please call 515-348-8258 and talk with a receptionist. Then download the following forms, print them off, fill them out and bring them with you or we will mail them to you if you prefer.
Our receptionists will want to know some details about what your concerns or problems might be and will need the information on your insurance card if you will be using insurance to pay for our services. We take cash, checks, Mastercard, VISA, Discover and American Express as forms of payment for services or insurance co-pays. Payments are due at time of service. For more information about our services please see our FAQ page.
In accordance with federal guidelines Central Iowa Psychological Services complies with all HIPAA regulations. Please see the privacy notice below in the forms section.
If you have any trouble downloading these forms, visit the Adobe website to download the free Acrobat Reader or call the office and we will assist you.
Please bring your completed forms with you to your appointment or arrive at least a half hour early to complete these documents for your therapist.
If you are an existing patient or have already completed the Intake Form, please click your preference below to be redirected to the appropriate Forms Page where you can view and print all applicable Appointment Forms for your visit.
Forms for Child Clients
Forms for Adolescent Clients
Forms for Adult Clients
Forms for Bariatric Clients
1. Privacy Notice (1 page PDF)
2. HIPAA Consent and Agreement Form (4 page PDF)
3. Patient Bill of Rights (1 page PDF)
4. Gastric Bypass Intake Form (6 page PDF)
5. Credit Card Payment Information (optional)