MOSAIC FAMILY Counseling Center Inc.
  • About
  • COVID-19
  • Our Family
  • Services
    • Psychotherapy Options
    • Telehealth
    • Telehealth en español
    • Groups
    • School Based Mental Health
    • Student Assistance Program
    • Assessments
    • Services for Professionals
    • Supervised Visitation & Parent Services
  • Rocha Consulting & Training
  • Interact with us
    • Our Blog
    • Request an Appointment
    • Helpful Forms
    • Privacy Policies
    • Helpful Links
    • Positions Available
    • Insurance/Forms of Payment
  • Staff Only
    • MFCC Orientation
  • Continuing Education

Helpful Forms for your visit 

Intake Brochure
The intake brochure holds important information about your rights and responsibilities as well as who to contact when you need answers. Please download and save for your records.*
mfcc_brochure_2014.pdf
File Size: 755 kb
File Type: pdf
Download File

mfcc_intake_brochure_2014.pdf
File Size: 521 kb
File Type: pdf
Download File

Intake Packet
The link below will take you to the online version of our intake paperwork, this entails a questionnaire that covers information that would normally be requested in an intake appointment. This questionnaire is designed to allow you to send us information that is needed so your first appointment is more successful for you.

The forms will take approximately 15 to 20 minutes to complete. Please fill it out in it's entirety so we may focus on the reason for your visit. This is a confidential system and you will be directed away from this website when you click on the link.
Online Intake Packet
If you would prefer to print and complete your intake paperwork manually, select the file below.
Employment Application Forms
mfcc_intake_packet_v2021_intakeq_version.pdf
File Size: 171 kb
File Type: pdf
Download File

Employee/Volunteer/Intern application form
File Size: 298 kb
File Type: pdf
Download File

massage_therapist_application_addendum_1_2019.pdf
File Size: 197 kb
File Type: pdf
Download File

* All forms are also available at the office.
Our Mission: MOSAIC FAMILY Counseling Center Inc. is the center of excellence in supporting the healing of life's challenges. Our Vision: We strive to provide holistic, nurturing and consistent therapeutic services to make meaningful connections. We support growth and change while being culturally responsive in a safe and comfortable environment that encourages others to become autonomous and successful.
MOSAIC FAMILY Counseling Center Inc.  • 6200 Aurora Ave, Suite 305E  • Urbandale, IA 50322
515.724.8920 P  •  888.771.3225 F  •  info@mosaicfamilyinc.com
  • About
  • COVID-19
  • Our Family
  • Services
    • Psychotherapy Options
    • Telehealth
    • Telehealth en español
    • Groups
    • School Based Mental Health
    • Student Assistance Program
    • Assessments
    • Services for Professionals
    • Supervised Visitation & Parent Services
  • Rocha Consulting & Training
  • Interact with us
    • Our Blog
    • Request an Appointment
    • Helpful Forms
    • Privacy Policies
    • Helpful Links
    • Positions Available
    • Insurance/Forms of Payment
  • Staff Only
    • MFCC Orientation
  • Continuing Education