top of page

Email = frontdesk@caciowa.com

Fax = 515-255-2228

CREDIT CARD AGREEMENT

Please download, print and sign this credit card agreement to use for balances due from you after your insurance processes your claims or if you are selfpay.  Please return the form to the email or fax above.  Thank you. 

Please print and complete the appropriate intake packet and return it with a copy of your insurance card and the credit card agreement to the email or fax above.  Once the packet, card and credit card agreement are received, we will call you to schedule an appointment.  Thank you. 

Doxy.me Telehealth Provider Links

RELEASE OF INFORMATION FORM

GOOD FAITH ESTIMATE FORM

TELEHEALTH CONSENT

Serving the entire Des Moines metro area in our West Des Moines office.
 

3737 Woodland Ave.
Suite 601
West Des Moines, IA
                       50266

      515-255-2224

© 2015 by Counseling Associates of Central Iowa   I   All Rights Reserved.   I   4401 Westown Pkwy, Suite 280, West Des Moines, Iowa 50266   I   515-255-2224

bottom of page