Save time: Completing these forms in advance can reduce your check-in time by 10–15 minutes. For telehealth visits, you can scan or photograph signed forms and upload via the patient portal, or email them to our office before your appointment.
Required for Telehealth Visits
All telehealth patients must complete these forms before their first visit.
Consent for Telehealth Services
Required for all telemedicine visits. Acknowledges understanding of telehealth services, limitations, and consent to participate. Valid for 6 months from your first telehealth visit.
Download PDFConsent, 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 PDFHow to Submit Your Forms
- Download & print the forms above, or fill on screen if your PDF viewer supports it.
- Fill out all applicable sections. Leave anything unclear blank — our staff can help.
- Sign and date where required.
- Submit in one of these ways:
- Upload via the patient portal (most secure option)
- Scan or photograph and email to our office before your visit
- Show during the start of your telehealth visit (we'll scan via the video)
- Bring physical copies for any in-person follow-up visits
Need help? Call us at 781-404-6172 (Woburn) or 781-281-7081 (Lynn) during business hours.
Questions?
Woburn: 781-404-6172 · Lynn: 781-281-7081