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New & existing patients

Patient forms

You will receive an email requesting standard forms before your appointment. Additional forms are available below.

Please download and complete the forms you need before your visit to save time at check-in. If you are unsure which forms apply to you, call 203-318-6143 for help.

1. Notice of Privacy PracticesPDF↓
2. Authorization for release of medical informationPDF↓
3. Telehealth consentDOCX↓
4. Credit card authorizationDOCX↓
5. Patient specialist formDOCX↓
6. Consent for treatmentPDF↓
7. Financial policyPDF↓
8. Language servicesPDF↓