Patient Information & Forms

Here you can download the Patient forms that you will need to complete prior to your first appointment.

 

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New Patient Questionnaire and Information Packet - HERE

 

Therapy Patient Forms - HERE

 

Adult ADHD Self-Report Scale - HERE

 

Anxiety Scale - HERE

 

Behavioral Health Release - HERE

 

Benzodiazepine Education - HERE

 

Depression Scale - HERE

 

HIPAA - HERE

 

Learning About Caffeine - HERE

 

Medical Release - HERE

 

Notice of Privacy Practices - HERE

 

Sleep Hygiene - HERE

 

Snap-IV - HERE

Patient Info & Forms

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1069 Central Street Leominster, MA 01453  |  Phone: 978-728-4957  |  Fax: 978-798-1366

TAK Center for Mental Health Leominster MA
TAK Center for Mental Health Leominster MA
TAK Center for Mental Health Leominster MA

INFORMATION REGARDING COVID-19, PLEASE CLICK HERE