MASKS ARE STRONGLY ENCOURAGED if unvaccinated, but are otherwise optional in the public areas of the office. We are following the lead of other health care providers in the area, but will update this as needed. Please have a discussion with your provider if you would be more comfortable to have them masked during your appointment.
With only the Federal Disaster Proclamation in effect Cedar Centre will need to transition all patients back to in person appointments. Phone only appointments will no longer be offered. If your insurance will still cover video appointments you will have to discuss that with your provider directly. 48 hour notice is required if you wish to switch your appointment from in person to video or you may be subject to a late cancellation fee and your appointment might be rescheduled.


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forms



Click on title of form to download



PLEASE DO NOT USE GOOGLE DOCS, MICROSOFT WORD, OR OPEN OFFICE TO EDIT THESE FILES. ADOBE READER HAS A FREE TOOL "FILL AND SIGN" WHICH WILL ALLOW YOU TO PUT TEXT INTO A PDF WITHOUT CHANGING THE FORMAT. OTHERWISE PLEASE CONTACT THE OFFICE TO HAVE THE PAPERWORK MAILED TO YOU. THANK YOU.


You may e-mail these forms to our e-mail drop box. This is for information use only, and not to be used for any medication, therapy or schedule requests. This email is not monitored 24 x 7. Please call the office with any questions. 319-365-3993.


Email: info@cedarcentrepsych.com



aDULT PSYCHIATRY



Dr Netolicky

Dr Hotsenpiller

Dr Weldon

Dr Wheaton-Adult

Dr Wolfe-Adult



cHILD & aDOLESCENT pSYCHIATRY



Dr Wheaton - Patient under 18

Dr Wolfe - Patient under 18



Forms for your information



HIPAA Privacy Notice

Office Policies



Therapist/Psychologist
for Adults



Paul Sundell

Christine Cork

Joan Tatarka

Ann Blake

Sandy Griffith

Mike Zochert




therapist/psychologist
for child & Adolescent



Paul Sundell - Patient under 18

Christine Cork - Patient under 18

Joan Tatarka - Patient under 18

Ann Blake - Patient under 18

Sandy Griffith - Patient under 18

Mike Zochert - Patient under 18



Specific Forms



Account information - "Gold Sheet"

Consent to start treatment - "Yellow Sheet"

New Patient information for under 18

Review of Systems for over 18

Behavior Checklist



Release of Information



CLICK HERE: Please use one release per other office or provider, as multiple names on one release will invalidate it.
When filling out a release for any form, paperwork or when you need us to send medical records to another office, please be aware that we have up to 30 days to complete all requests.
If you have a date that your information must be completed by, please include that with your request. BE AWARE, it may still take up to 30 days to complete the request.
When completing our release, please do NOT initial the boxes in the middle unless you do NOT want us to send your Mental Health / Substance Abuse / HIV/AIDS or Genetic Information. If the paperwork requires this information you will delay completion of your request and we will need to ask you for a new release.



Other Forms



PHI Request

EZ Pay Consent form

TMS Consent form