Client Forms

Instructions for completing forms:

  • Begin by clicking on a form link below, you will be directed to a secure site. 
  • Please fill out all of the following forms in the appropriate category for you as a client. 
  • Once you begin a form, you will need to fully complete and submit it, or the partial information will be lost, and you will need to begin that form again, from the beginning. You do not need to complete all of the forms in one sitting. Please fill out form to completion prior to submitting. You have two hours to complete each form.  If a form is not completed within two hours, the form will time out and you will lose information entered on that form.
  • You will notice some forms have a space at the bottom for you to sign with Topaz. This signature can only be provided in our office when you come in for your Evaluation.  When all questions of a form have been completed, click on "Submit".
  • Thank you, and please call us if you have any questions (563-382-3649 or 319-283-5774  or Toll-free, 800-400-8923).

NEW CLIENTS AGE 13 +

NEW CLIENTS 12 and under

NEW IHH CLIENTS

RELEASE FORMS: