319.382.4720 • Get Directions
HIPAA Notice of Privacy Practices (for all clients)
Review and complete this document prior to your first session. It contains information on how your private medical information is used and accessed.
Julian & Associates Service Agreement
Review and complete this document prior to your first session. It contains information on Julian & Associates services, fees and privacy details.
Intake Form (for all clients)
Please complete this form prior to your first session.
It informs us about you, your history and your counseling goals and needs.
Limits of Confidentiality
Sessions with your counselor are considered confidential. This document outlines possible exceptions. Please download, review and sign prior to your first session.
Release of Information for Nikki
If you would like Nikki to speak with any one (e.g., primary care physician, psychiatrist, etc) regarding your treatment, complete this document and bring to your first session.
Electronic Payment Authorization
Download and complete this form if you intend to pay for session fees
via credit card.
Julian & Associates logo design by Chris Reese with Creative Recourse.
Forms keep both counselor and client informed and prepared