Forms and Policies

Intake Forms (see below)


Please read ALL the following forms. 

- Welcome!    

- Client Rights

- Notice of Privacy Practices


Those with an * need to be printed and completed prior to first appointment.


*Adult Assessment  OR  *Child Assessment

*Consent to Treat

* Copy of insurance card, both sides

*Release and Coordination of Care 

  (one for each)

    (1) Primary Care Physician

    (1) Psychiatric medication provider


Contacting Me


You can reach me by calling 978-866-1435


I will make every effort to return your call within 24 hours, with the exception of weekends and holidays and days I am not in the office. I am typically in the office on Monday, Wednesday, Thursday and Friday. 


If you feel in crisis and are either unable to reach me or feel that you can not wait for me to return your call, please contact your family physician or go to the nearest emergency room. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact if necessary. 

Missed Appointments and Cancellations

Your appointment time is reserved just for you. Please let me know as soon as you can if you need to reschedule your appointment so I can offer the time to someone else who might need it. If you let me know at least 24 hours ahead of time, you can avoid the $50.00 (no-show or late cancel) missed appointment fee. This charge is not covered by insurance. ‚Äč   

Please read the following forms:

Client Rights (pdf)

Download

HIPPA-Privacy Practices (pdf)

Download

Welcome Letter 2019 (docx)

Download

Please print the following forms:

Please also make a copy your insurance card, both sides.

Adult_Self_Assessment (pdf)

Download

Child Assessment (pdf)

Download

Consent-Release (pdf)

Download

Release and Coordination of Care (docx)

Download