Intake Paperwork

Due to the high volume of patients, we are no longer able to accept all new patients if you would like to become a new patient, please fill out the Pre-screening Questionnaire below. We will review it and determine if NENH is a good match for your needs. NENH staff will then contact you to either schedule an initial consultation or give you suggestions for referrals. If NENH is a good match for your needs, you will be asked to please fill out the intake paperwork listed below.

NENH requests that you submit your Intake paperwork prior to arriving at the office for your Initial Consultation. Filling out our Intake will take you a minimum of 15 minutes and detail is welcome. Please remember to sign the Consent for Treatment and initial each item of the Payment Policy.

Pre-screening Questionnaire Pediatric Intake Paperwork Electronic Pediatric Intake Paperwork Adult Intake Paperwork Electronic Adult Intake Paperwork