(978) 679-1200

Forms & Policies

Please find some of our most frequently used forms and handouts below. If you have patient portal access, you can request to complete and submit the forms via the patient portal.

Forms

  • Authorization to Release/Exchange Protected Health Information
  • Assignment of Insurance Benefits
  • Designation of Personal Representative
  • Notice of Privacy Practices Acknowledgement and Consent
  • Authorization for Credit Card Use
  • Consent for Treatment – Medications
  • Consent for Treatment – Therapy Agreement
  • Advance Beneficiary Notice
  • Divorced Parents Form

Policies Handouts

  • Notice of Privacy Practices Trifold
  • Patient Rights and Responsibilities
  • Refill Policy
  • Billing Policy
  • Late Policy
  • Cancellation Policy
  • Discharge Policy
  • No Show Policy
  • Transfer Policy

The New England Center is OPEN today Tuesday December 3, 2019, during normal hours

Office Hours

  • Tuesday : 09:00 – 20:00 hrs