Dear Client:  We are glad you are here to visit us. You can use the links below to fill out forms before you visit us in the office. Please read the instructions below carefully.  If you have any questions, don’t hesitate to call in for assistance or email us at information@addsiowa.org

Once you submit your forms, please let us know that you did by emailing us at information@addsiowa.org and/or calling us at any of these locations listed on our homepage.

Here for an evaluation? Please complete forms 1 – 5.  Are you getting admitted today?  Please complete forms 1-6.

1. Additional Assessment

2. ACEs Questionnaire

3. Patient Health Questionnaire – 9 (evaluations only)

4. Alcohol Use Disorder Identification Test

5. Drug Abuse Screening Test

6. Activities of Daily Living

ADDS Release of Information

ADDS Criminal Justice Release of Information 

Referral Form for Substance Use Evaluations

Initial Client Information Form

PHQ-9 Update (use if your counselor asked you to complete this)

ADDS Telehealth Client Survey

Making a Referral to Peer Recovery

Community Agencies – Any community agency can make a referral to a peer recovery coach using this form!

EMS / Law Enforcement / First Responders – Any First Responder can make a referral to a peer recovery coach using this form!

Hospitals / EDs – Any Hospital / ED can make a referral to a peer recovery coach using this form!

Need Financial Assistance?

Please fill out our fee assistance application below. Click the link and download the form and print to bring it into one of our offices. You may also feel free to download this form as a PDF and fill it out on your computer and email it to staff in an office near you. Use this link to find the contact information for our staff.

You will need to follow all the instructions on the form or risk us rejecting the application.

Fee Assistance Application