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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 a 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.


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

patient_agreement_rev_4.2020_000055.pdf
File Size: 4233 kb
File Type: pdf
Download File


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

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

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

new_patient data.pdf
File Size: 498 kb
File Type: pdf
Download File

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

medical_history_.pdf
File Size: 161 kb
File Type: pdf
Download File

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

mental_health_intake_form.pdf
File Size: 129 kb
File Type: pdf
Download File

SUBOXONE SPECIFIC DOWNLOADS
img_suboxone_treatment-agreement_copy.pdf
File Size: 179 kb
File Type: pdf
Download File

buprenorphine_maintenance_treatment.pdf
File Size: 148 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
​

​© 2016-2017 Insight Medical Group, LLC All Rights Reserved
428 Lafayette Rd Hampton, NH. 03842​
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