Patient Information

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

We accept most commercial health insurance plans. We will facilitate the submission process for In-Network policies.  

Please print and complete forms 1 through 3.

Please bring these forms to the intake appointment.

 Patient Forms required for Intake: 6 forms

1. Patient Information & Insurance Information (2 forms)
2. Patient / Responsible Party Financial Agreement (1 form)
3. Patient / Responsible Party ADDITIONAL SERVICES (1 form)
4. Patient No Show Policy & HIPAA Policy (2 forms)

Patient copies:

1. Summary of Payment Terms & Urgent Care Policy
2. Office HIPAA Policy page 1,page 2, page 3, page 4