Request an Appointment - Psych Testing

Request an Appointment

If you would like to learn more or schedule a psychological testing appointment for yourself or your child or individual in your care, please reach out to our Intake Coordinators at 319-626-3300 or fill out the following form.
Patient Name

First NameLast Name
Date of Birth*

MonthDayYear
Date
Guardian Name (if applicable)

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Preferred Contact Method

PhoneEmail
Insurance Type
(i.e Blue Cross, UHC, etc.)
Has the Patient had previous Psychological Assessments?

YesNoUnsure
Additional Information
Should be Empty: