New England Center For Anxiety
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Forms for new adult clients.

Please complete the following forms and bring them along with your insurance card to your intake appointment.
Consent Form for Adult Clients
File Size: 391 kb
File Type: pdf
Download File

Adult Intake Form
File Size: 336 kb
File Type: pdf
Download File

Consent to Use and Disclose PHI
File Size: 353 kb
File Type: pdf
Download File

Patient Responsibility Form
File Size: 355 kb
File Type: pdf
Download File

Privacy Policies
File Size: 359 kb
File Type: pdf
Download File

Employee Assistance Program Form (for clients using EAP benefits)
File Size: 37 kb
File Type: pdf
Download File


Forms for new child clients.

Please complete the following forms and bring them along with your insurance card to your intake appointment.
Parent Consent Form for Child Clients
File Size: 387 kb
File Type: pdf
Download File

Assent Form for Adolescents (to be completed by adolescents aged 13-17)
File Size: 378 kb
File Type: pdf
Download File

Child History Form (to be completed by parent)
File Size: 430 kb
File Type: pdf
Download File

History Form (to be completed by adolescents aged 13-17)
File Size: 346 kb
File Type: pdf
Download File

Consent to Use/Disclose PHI
File Size: 353 kb
File Type: pdf
Download File

Patient Responsibility Form
File Size: 355 kb
File Type: pdf
Download File

Privacy Policies
File Size: 359 kb
File Type: pdf
Download File

Employee Assistance Program Form (for clients using EAP benefits)
File Size: 37 kb
File Type: pdf
Download File

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