Intake Paperwork

If you would like to become a new patient, please fill out the screening questionnaire below and either mail or email it to the office. Dr. Marinaro 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.

NENH requests that you download, print and fill out 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.

New Patient Questionnaire Pediatric Intake Paperwork Adult Intake Paperwork