Phone: 214.706.0508 | Fax: 214.607.0515
Address: 8140 Walnut Hill Lane, Suite 450, Dallas, TX 75231
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Providing Professional Counseling Services

Mary Sanger’s Forms

THERAPY FORMS

What are these forms?

  1. Adult Intake Form, Minor Intake Form.  These forms provide information about you or you child so Insights can craft therapy to be as effective and efficient as possible. Some questions are personal and may be sensitive or even uncomfortable. They are asked in an effort to quickly begin building a complete picture of who you or your child are, which in turn will save valuable therapy time. All client records are strictly confidential and will not be seen by anyone without your written permission unless required by law. If you have any questions, please discuss them with your therapist.
  2. Informed Consent to Treat form. This form details your rights and responsibilities as a client and consents for me to treat you.

 Which forms should I use?

If you are an adult, use these forms:

If your child is the new client, use these forms:

 What do I do with these forms?

Please print, complete and bring your Adult Intake Form or Minor Intake Form and Informed Consent to Treat forms to your first session. That way, we will be able to begin therapy at the start of the first appointment.

 

MEDIATION FORMS

What are these forms?

  1. Mediation Intake Form. This form asks for information about you and your situation so your mediation can be as effective and efficient as possible. Some questions are personal and may seem sensitive, but they are asked to save valuable mediation time. Although you may not have all the information at this time, please answer the questions to the best of your ability. This form and all your mediation records are strictly confidential and will not be seen by anyone without your written permission unless required by law. If you have any questions, please discuss them with Mary Sanger.
  2. Informed Consent to Treat form. This form details your rights and responsibilities as a mediation client and consents for Mary Sanger to mediate your case. Mediation is a form of professional therapeutic services which Mary Sanger is authorized by law to perform.
  3. Agreement to Mediate form. This form is an agreement between you and the other party to mediate your case.
  4. Credit Card Authorization form. This form authorizes Insights to charge your credit or debit card for mediation services as stated in the Informed Consent to Treat.

Which forms should I use?

  1. Mediation Intake Form
  2. Informed Consent to Treat
  3. Agreement to Mediate
  4. Credit Card Authorization

What do I do with these forms?

Please print, complete and either fax or scan and email these forms to Mary Sanger in advance of you mediation session.  That way, Mary Sanger will be able to prepare and be ready to begin your mediation at the first mediation session.

 

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