Become a Patient

To become a new patient please complete the following forms as appropriate and return them to our office. We also request that you submit the “Authorization to Use and Disclose PHI” form to your previous physician to have your records transferred to our office prior to your first visit.

Please call our office at (978) 577-0437 to schedule an appointment for your child.

Online Registration Forms

Registration Forms (Print Versions)

To become a new patient please complete the following forms as appropriate and return them to our office. Forms may be printed at home and brought to your appointment. We also request that you submit the “Authorization to Use and Disclose PHI” form (see next section below) to your previous physician to have your records transferred to our office prior to your first visit.

Registration Forms (print version)

HIPAA ~ Acknowledgement Form Minors

HIPAA ~ Acknowledgement Form 18+

Other Forms

To become a new patient we request that you submit the “Authorization to Use and Disclose PHI” form to your previous physician to have your records transferred to our office prior to your first visit.

Authorization to Use and Disclose PHI

Consent to See and Treat

Divorced Parents – Informed Consent