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Practice Policies and Patient Forms

Use these resources to prepare for your visit to Pink Couch Wellness.

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Patient Handbook

Welcome to Pink Couch Wellness! The information included in our Patient Handbook outlines our practice policies and procedures for appointments, insurance and payments, required reporting, and more.

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Patient Forms

Forms may be completed online using the SimplePractice App or downloaded and completed on a hard copy.

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PCW Credit Card Authorization​

PCW Insurance Waiver

PCW Consent for Telehealth

PCW Adult Intake Questionnaire

PCW Consent to Treat

Pink Couch Wellness accepts insurance from: BCBS, Optum/UHC, Aetna, Midlands Choice, Iowa Total Care, Molina, and Health Partners.​ 

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© 2026 by Pink Couch Wellness | Policies

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