Patient Forms

To schedule an appointment call 860-767-1277 ext. 201

We accept most health insurance plans and will facilitate the submission process.

Please print and complete forms 1 through 3.

Please bring these forms to the intake appointment.


  1. Patient Information and Insurance Form  (2 forms)
  2. Financial Agreement (1 form)
  3. No Show / Cancellation Policy / HIPAA Policy (2 forms)
  4. Patient copy: Financial Agreement & Urgent Care Policy


   Notice of Privacy Practices - HIPAA