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Patient Information Form

Psychotherapist-Patient Agreement
(Read-Only, does not need to be printed)

HIPAA Information
(Read-only, does not need to be printed)

HIPAA Signature Form

Intake Questionnaire for Adults

Intake Questionnaire for Adolescents

HICFA1500 form (to be filled out by Cigna clients only)

Forms

Please read the Psychotherapist-Patient
Agreement and the HIPAA Information form
prior to your first appointment.

Please print and fill out the forms on this
page (indicated in bold) prior to your first
appointment. Bring the forms with you to
your first appointment.

Thank you.

Jennifer Lager, Psy.D.

Helping individuals, couples, and families improve relationships, accentuate strengths, and maximize potential