Improving the Quality of Life for
Children, Adolescents and their Families
289 Great Road, Acton, MA 01720
(978) 679-1200

Forms and Policies

The following forms can be sent to you through the patient portal. If you would prefer to fill these forms out electronically, please contact us at 978-679-1200 to request a specific form be sent to you via the patient portal.

Forms for Teachers - Parents, please print and give to your child's teacher(s)

Forms for Patient's coming in for Therapy - please fill out and bring to your therapy session

  1. Welcome Letter
  2. Therapy Agreement
  3. Mature Minor Form * to be used in the case of emancipation

Inclement weather & cancellation policy

New England Center for Healthy Minds is committed to offering the same high quality care for its patients throughout the year. Because of this, we attempt to stay open as much as possible even during inclement weather.

The providers and staff at New England Center for Healthy Minds never want our patients to jeopardize their safety and travel to an appointment if they are uncomfortable; however, we do staff our office to meet the demands of the patients we serve and strive to ensure ample staffing even during inclement weather.

We do not charge cancellation fees based on the following criteria:

  • If your school district cancels due to inclement weather, we will waive all cancellation fees.
  • If your school district has an early dismissal due to inclement weather, we will waive all cancellations fees beginning at noon time.
  • If your school district has a delayed opening, we will waive all fees for cancellations for the morning. Any appointments after 11:00 A.M. that are cancelled will incur the fee.
  • If your school district is not in session, we will waive cancellation fees in the event of a winter weather warning in your county.
  • If you do not call to cancel your appointment or fail to show for a booked appointment, you will be charged the no show fee. It is the patient’s responsibility to communicate with our office regarding their ability to make their appointment.
  • We will offer each family a One-Time per year Courtesy Waiver for any no-showed appointment for any reason, because we understand that life with kids is busy. This will be documented in our billing records for reference.

New England Center for Healthy Minds will continue to assess each impending storm and the needs of our patients and the practice.