Quick tip: Bringing completed forms to your appointment can reduce your check-in time by 15–20 minutes. If you have questions filling them out, our staff is happy to help when you arrive — just leave any unclear sections blank.
Required for New Patients
All new patients must complete these forms at or before their first visit.
Consent, HIPAA & Financial Forms
Complete packet including Consent for Treatment & Payment, Notice of Privacy Practices acknowledgement, Credit Card on File Agreement, and Patient Financial Responsibility.
Download PDFNotice of Privacy Practices (Full)
The complete HIPAA Notice of Privacy Practices explaining how your protected health information may be used and disclosed, and your rights regarding that information.
Download PDFFor Telemedicine Visits
Complete this if you're scheduling a telehealth (virtual) visit.
Consent for Telehealth Services
Required for all patients receiving telemedicine (virtual) visits. Acknowledges understanding of telehealth services, limitations, and consent to participate. Valid for 6 months from your first telehealth visit.
Download PDFHow to Use These Forms
- Download & print the forms above. (You'll need a PDF viewer like Adobe Reader, Preview on Mac, or your browser.)
- Fill out all sections that apply to you. Leave any unclear sections blank — our staff can help when you arrive.
- Sign and date where required. If you're completing forms for a minor child or as a guardian, write your relationship to the patient.
- Bring the completed forms with you to your appointment. For telehealth visits, please scan or photograph signed forms and either email them in advance or have them ready during your visit.
Need help? Call our office at 781-404-6172 during business hours. We're happy to assist with any questions about these forms.
Questions?
Call us anytime at 781-404-6172
MTH Specialty LLC · 19 Pleasant Street, Suite 101A · Woburn, MA 01801