Below are forms that must be completed before participation or treatment can begin. Click on the appropriate link to download a form or contact us at 860-667-5480 to have forms mailed or faxed to you.

Medical History Form (English)
Medical History Form (Spanish)
Consent Form for Uses of Protected Health Information
(privacy form) (English)

Consent Form for Uses of Protected Health Information
(privacy form) (Spanish)

Consent to Treat (English)
Consent to Treat (Spanish)
Authorization to Release PHI to Outside Parties (English)
Authorization to Release PHI to Outside Parties (Spanish)



181 Patricia M. Genova Drive    Newington, CT 06111    860.667.5480    Fax 860.667.8416    Privacy Statement: English Spanish