Counseling Services Nancy K. Vermeersch, LISW

Licensed Counselor/Therapist

Phone: 319-550-1621
Text: 319-343-6371
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Counseling Forms

Please complete ALL of the following forms. Hit the submit button at the bottom of Secure Form 1 and Secure Form 2.  PLEASE COMPLETE and send via Secure PDF file the CAFFEINE Questionnaire and DEPRESSION Inventory to nkvlcsw@therapysecure.com.  OR print them and bring them with you to the first session.  This will save time and allow us to begin our conversations right when your session begins. If you have any questions about the forms, please contact me.

  • Secure Form 1
  • Secure Form 2
  • Notice of Privacy Practices
  • Caffeine Questionnaire
  • Depression Inventory
  • Communications Policy (for your records)

Are you ready for a change? Reach out today.

Phone (Landline):
319-550-1621

Secure Voice and Text:
319-302-9444

Email:
nkvlcsw@therapysecure.com

Address:
4403 1st Avenue SE, Suite 215
Cedar Rapids, Iowa 52402