Pre-screening Questionnaire

Due to the high volume of patients, we are no longer able to accept all new patient requests. If you would like to become a new patient, please fill out the Pre-Screening Questionnaire and click “Submit” at the bottom of the page. Alternatively, you may click the link below to print out the form and send it to us or drop it off at our office.

Once we receive your Pre-Screening Questionnaire, 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. The link for this paperwork is at the top of the page.

Pre-screening Questionnaire