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.
All Client Forms
To be completed by an adult and/or parent/guardian.
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]
To be completed by an adult or a representative accompanied by the adult.
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.
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]
To be completed by the primary/legal guardian of the child.
Contains child developmental history as it relates to treatment.
Child developmental history_Updated JULY[...]
Adobe Acrobat document [49.4 KB]
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.