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Secured Connections & Wellness Home Page
How We Help
Services
Times of Crisis
Caregiver Resources & Links
Videos and Learning
Make a Referral
Paperwork
Client Portal
How We Help
Services
Times of Crisis
Caregiver Resources & Links
Videos and Learning
Make a Referral
Paperwork
Client Portal

Client Paperwork

  • Secured Connections & Wellness - Release of Information

  • Client Copy of Privacy Practices

  • Client Financial Responsibility & Permission to bill Insurance Form

  • Consent To Treat - Adult Client

  • Consent To Treat - Minor Client

  • Authorization for Recoding Sessions - for Therapy Interns at Secured Connections

  • Demographics and Insurance Information Client Form

  • Pediatric Questionnaire

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Secured Connections & Wellness

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photo credits:

ID 118582849© Andrii Yalanskyi| Dreamstime.com

ID 232760599 | Father Teen Son © Svitlana Ponurkina | Dreamstime.com

ID 244394304 © Svitlana Ponurkina | Dreamstime.com

ID 163080627 | Angry Child © Nadezhda1906 | Dreamstime.com

ID 43372960 | Angry Child © Antonio De Azevedo Negrao | Dreamstime.com

97689503 | Adhd Angry Boy © Katarzyna Bialasiewicz | Dreamstime.com

ID 316810081 | Adhd Boy © Satjawat Boontanataweepol | Dreamstime.com

Location

950 Office Park Road Suite 125
West Des Moines, Iowa 50265

Contact

info@securedconnections.net
(515) 207-0319