Helpful Forms and Information for Working With Peggy L. Ferguson, Ph.D., Stillwater, OK

 

 

Patient Forms

Patient Forms can be downloaded and/or printed off from the clickable PDFs or
Word Documents at the Bottom of the Page

If you're a first-time client, please review and complete the following forms, and either bring them to your first session or fax them before your first session.  These forms are provided for your convenience.  It is not required that you have them filled out before our first meeting.  
All new patients will be required to fill out the following three forms:  Consent for Services, Personal History Form, and Facesheet (for one or more people)
 

Consent for Services

Personal History Form



Face Sheet Form                                              

 

If you are on a family insurance plan and the "policy holder/insured" is not you, please have the insured fill out and sign this form
 

 

Insured's Release

If another person is financially responsible for your counseling fees, please have them fill out this form and bring it with you.

Insured's Financial Agreement

 

 

 

If you would like me to coordinate care or release information to another provider (for example, your psychiatrist, endocrinologist, etc.), lawyer, or any other person designated by you, please complete this form:

Consent to Release Information Form

 

 

 

 

 

 

If you would like for me to find out about your insurance benefits before your appointment, please print  the insurance release, sign it, and fax it back to me with a copy of your insurance card (both sides) and a copy of the face sheet with your demographic information.

Insurance Release Form

 

 

 

 

 

 

 

 

 

If you are not seeking counseling with me at this time, but would like to consult with me about some specific issue, you may set up an appointment for consultation either over the telephone or by internet.  Any consultation session is for educational/informational purposes only and does not constitute a therapeutic relationship.  Consultation is not intended to substitute for advice or treatment of a marital or addiction therapist or other mental health professional.  It is not intended to be used to diagnose, treat, cure, or prevent any disease or illness (including mental illness). 

Phone Consultation Form

 

 

 

 

 

 

 

 

 

 

 

Free Information Downloads

 

 

 

 

 

There are several free downloadable workbooks or booklets listed below.  They are in public domain and are written and/or published by governmental agencies or departments.  All of the booklets and workbooks in PDF format are excellent sources of information.  Click below on the PDF icons to access these recources.

Anger Management Workbook


Depression Booklet


Anxiety Disorder Booklet


Panic Disorder Booklet

 

 

 

 

 

Note: To download Adobe Acrobat Reader for free, click here.

"Small opportunities are often the beginning of great enterprises."  Demosthenes

 

 

 

 

 

 

 

---