Please Read the Following Before Filling Out the Form Below:
- New England Psychiatry ONLY offers psychotherapy and medication management. Ethically, we can ONLY accept patients that do not require community/additional services.
- Be advised that if information is withheld from the intake form or the provider is placed in a compromised position when providing services, New England Psychiatry has the right to deny and transfer services.
- New England Psychiatry is not responsible for understanding your insurance policy benefits. Please be aware of what your insurance premium covers and what your financial responsibilities are (deductibles, co-pays, coinsurance, etc.). These will be charged at time of services rendered.
- For TELE HEALTH appointments, a credit card is REQUIRED to be kept on file and will be asked for before the initial appointment.
This form is to be completed prior to contacting the office if you are requesting an appointment as a potential new patient. Review of form and return call will occur within 24 hours during office hours (excluding national holidays).
Office hours are M-TH from 09:00-17:00. We can be reached at (603) 600-8513. You may leave a voicemail and we will return your call within 24 hours during office hours.