To view or download a copy of our Notice of Privacy Practices, click here.
If you have questions, concerns, or would like additional information regarding the issues covered by this Notice of Privacy Practices, or if you seek additional information regarding Catholic Charities’ privacy policies and procedures, you may contact us at 1229 Mount Loretta Avenue, Dubuque, IA 52003 or 800-772-2758.
Please click here to read our Client Handbook.
These forms are available for you to print, complete and bring with you to your first visit. Please do not email these forms.
- Intake Form in English
- Receipt of Client Information & Consent for Treatment
- Intake Form in Spanish
- Receipt of Client Information & Consent for Treatment in Spanish
The following information is also available to print, complete and bring with you to a session as needed. Please do not email these forms.
- Consent to Interview/Counsel a Minor
- Client Authorization to Release Information
- Consent to Interview/Counsel a Minor in Spanish
- Client Authorization to Release Information in Spanish
For questions, contact Lynne Lutze, Clinical Director at email@example.com.