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​Insight Medical Group LLC


FORMS

Being given an appointment does NOT automatically mean you are

accepted as a patient of this practice. The first appointment and

agreement between the patient and provider must follow.

new clients: please read and sign a copy of the agreement below.

* Telemedicine patients cannot be seen until we recieve the originating paperwork

​  as advised on your phone interview.

Please download and fill out the forms below before your first office visit if at all possible to save time ...
New Mental Health Patients :  1st 6 files, the inventories at the right are helpful but not required unless requested.
* any overlap in the questions on the forms need only be answered once.
 

Buprenorphine/ Suboxone patients , may add the bottom group.


​
new_pt__1_.pdf
File Size: 498 kb
File Type: pdf
Download File


hippa_rights__0001045.pdf
File Size: 350 kb
File Type: pdf
Download File

patient_agreement_rev_2022_000055.pdf
File Size: 3041 kb
File Type: pdf
Download File

telepsychiatry_consent.pdf
File Size: 73 kb
File Type: pdf
Download File

medical_history_copy1__1_.pdf
File Size: 182 kb
File Type: pdf
Download File

mental_health_intake_form.pdf
File Size: 222 kb
File Type: pdf
Download File

anxiety-inventroy.pdf
File Size: 28 kb
File Type: pdf
Download File

mdq_questionnaire.pdf
File Size: 48 kb
File Type: pdf
Download File

depression-inventory.pdf
File Size: 67 kb
File Type: pdf
Download File

consent_to_release_of_confidential_info.pdf
File Size: 187 kb
File Type: pdf
Download File

SUBOXONE SPECIFIC DOWNLOADS
img_suboxone_treatment-agreement_copy.pdf
File Size: 274 kb
File Type: pdf
Download File

new_suboxone_patient_info.pdf
File Size: 75 kb
File Type: pdf
Download File

Contact Us


Outside Agency Help Lines:
New Hampshire Statewide Addiction Crisis Line:
1-844-711-HELP (4357)   24/7


ANY Crisis Text HOT Line:   TEXT "GO" to 741741
National Suicide Prevention Lifeline (24/7):   1-800-273-8255    
Domestic Violence (24/7):   1-866-644-3574
Sexual Assault (24/7):   1-800-277-5570
​

​© 2016-2021 Insight Medical Group, LLC All Rights Reserved
428 Lafayette Rd Hampton, NH. 03842​
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