Dr. Wagner can provide telehealth for you or your child if you live in a PsyPact state. Click here for more.

Forms

Below are Dr. Wagner's forms for new patients. Please download, print, and fill out the forms in the order they are listed, and bring them to your first appointment with her. 

Forms for Parents of Children and Teens:

  1. First Appointment Letter - Child 
  2. Child History Form
  3. History of Symptoms - Child
  4. HIPAA Privacy Notice
  5. Client-Therapist Services Agreement
  6. Authorization for Information Exchange

 Forms for Adults:

  1. First Appointment Letter - Adult
  2. Background History - Adult
  3. History of Symptoms - Adult
  4. HIPAA Privacy Notice
  5. Client-Therapist Services Agreement
  6. Authorization for Information Exchange