Counseling Forms

 Please fill out these forms and bring them to our office along with your insurance card.  You may also stop by our office M-F, 9am-4pm to fill them out in person.  We must have all this information before assigning you to a therapist.

United Action for Youth

We are here to support you.  Don't hesitate to contact us if you have any questions about how we can work together.

Phone: 319-338-7518

Fax: 319-337-7999

PO Box 892 Iowa City, IA 52244

© 2018 by United Action for Youth. Proudly created with Wix.com