New Client Forms

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.

 

Select the appropriate forms you will need, print the documents and return the completed documents to our practice in person at your first scheduled appointment. All forms are also available at the practice; however, filling them out in advance saves time.

 

Referral forms are also availble for download.
 
If you are unsure which forms to fill out, don't hesitate to contact us.

All Client Forms

To be completed by an adult and/or parent/guardian.

New Client Demographic Information
Contains demographic information such as address; telephone; work and family; emergency contact and other important information.
Client Demographic Information Form_Upda[...]
Adobe Acrobat document [71.8 KB]

Adult Forms

To be completed by an adult or a representative accompanied by the adult.

Adult Checklist of Concerns
Contains list of concerns related to an adult that would be relevant to treatment.
Adult checklist of concerns_Updated JULY[...]
Adobe Acrobat document [45.3 KB]

Young Adult Forms (Age 13-17)

To be completed by the young adult.

Young Adult Information
To be completed by the young adults ages from 13 to 17 years.
Young Adult Information Form_Updated JUL[...]
Adobe Acrobat document [67.9 KB]

Child/Adolescent Forms

To be completed by the primary/legal guardian of the child.

Child Development History
Contains child developmental history as it relates to treatment.
Child developmental history_Updated JULY[...]
Adobe Acrobat document [49.4 KB]
Child Checklist of Concerns
Contains a checklist of concerns for a child that can be relevant for seeking services with Wagner Behavioral Health Services,LLC.
Child Checklist of concerns-UPDATED JULY[...]
Adobe Acrobat document [72.4 KB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.