Call (978) 222-3121

If you are a NEW client, please complete the “New Client Registration Form” on the Home Page. Please only complete the form below “Intake Form”  if you have been instructed to by one of our staff members.

This form is only intended for clients who have already spoken to our intake team.

Intake Form (online form).

 

Other Useful Forms:

Notice of Privacy Policy
Download File
Electronic Communication
Download File

If you are new to our medication management program please complete the two forms below, and bring them to your first appointment.

Medical History Form
Download File
Psych Meds Policy
Download File

If you would like us to coordinate care with another provider, complete the Authorization to Release Information form below. You can use the Restrictions on Communication form (below) to specify certain information that you do not want to be shared.

Click here for the Communication Authorization (online form).

 

If you need all or part of your counseling record. ​Please allow 4-5 business days to process.

Record Request Form
Download File

Insurance Update Form

Please complete the form below if you are an existing client, or if you are a new client who has been instructed to provide additional insurance information.

Insurance Update Form