Pre-screening Questionnaire

Due to the high volume of new patients NENH receives, we have implemented a pre-screening process to ensure that NENH is a good match for your needs as a patient. 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, we will schedule your New Patient Appointment. Please note that payment for the first appointment only is due at the time of booking. Once your New Patient Appointment is booked, please fill out an submit the New Patient Intake Paperwork (Adult or Pediatric as appropriate), which can be found here