Intake Information Form
This form must be completed prior to your first session and
sent to our office staff to assist with billing your insurance company.
You can mail, email, fax, or deliver in person this form.
New Client Information
Information for New Clients. Please download for your own records.
Adult Intake Form
Provides Dr. Sager with basic information regarding past medical history,
relationships, employment, and presenting concerns. Please print this out and complete prior to our first or
second session. Feel free to omit any questions that you are uncomfortable with or would rather discuss in person.
Terms of Service Form
Standard form which covers late cancellation fees and agreement to pay
copay/deductible for provided services. Please print this out and complete prior to our first or second session.
If you have any questions, please discuss them prior to signing this agreement.
Notice of Private Practices - HIPPA
We are required by law to maintain the privacy of protected health information, and
must inform you of our privacy practices and legal duties. If you are going to use insurance,
then please print this form and bring a signed copy to our office.
Authorization to Release Information
If you would like me to speak to someone about your psychological progress
(a medical doctor, a new therapist, a professor) or to have someone give me information about prior psychological/medical
progress/history, then a release of information must be signed. Please use this form when requesting that I speak to
or send information to another person/agency.
Anxiety and Phobia Workbook Bourne
Post Traumatic Stress Disorder Workbook Williams & Poijula
When Food is Love - Roth
Nothing to Lose Erdman
Transforming Body Image - Hutchinson
Transgender Emergence Lev
My Gender Workbook Bornstein
The New Goddess Teague
Coping With Crossdressing Roberts
Crossdressing with Dignity Rudd
My Husband Wears My Clothes - Rudd
African/Black American Women:
Nappy: Growing up Black and Female in America Gibson
Going Off Childs and Palmer
Lies My Teacher Told Me Loewen
40 Ways to Raise a Nonracist Child Mathias & French
Becoming Multiculturally Responsible on Campus Parker & Sager
Everyday Acts Against Racism Reddy
Its the Little Things Williams
Why Are All the Black Kids Sitting Together in the Cafeteria - Tatum
The Complete Idiots Guide to Verbal Defense
The Missing Piece Meets the Big O Silverstein
The Dot and the Line - Juster
Stop Walking on Eggshells Mason & Kreger
Stop Walking on Eggshells Workbook Kreger & Shirley
Toxic Parents - Forward
Children of the Self-Absorbed - Brown
Self-Esteem / Motivation
Who Moved My Cheese - Johnson
When I Say No I Feel Guilty - Smith
Your Perfect Right Alberti & Emmons
Complete Idiots Guide to Self-Esteem Warner
Gay Relationships Tessina
Dual Attraction Weinberg et al.
Vice Versa Garber
On Being Gay - McNaught
Stress Reduction and Relaxation
Relaxation and Stress Reduction Workshop Davis et al.
Gift of Fear De Becker
I Cant Get Over It Matsakis
Trust After Trauma - Matsakis
Childhood Sexual Abuse, Rape:
Courage to Heal Davis
Victims No Longer (men recovering) Lew
I Never Called It Rape - Warshaw
Dance of Anger - Lerner
College Womans Handbook Dobkin & Sippy
Web References, Articles and Local Resources
Stress in America
Explains the growing problem of stress in US society. Includes a stress quiz and a stress tip sheet.