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Kerzner Online patient intake form

PATIENT INTAKE INFO

Have you been seen by a clinician? Then read carefully the steps below. If not, please find your clinician first.

Patient Intake Info

NEW PATIENT INFORMATION

STEP 1: Before your appointment:

  • Contact your insurance company to find out about co-pays, deductibles and any preauthorization you made need.

STEP 2: Schedule an appointment with our Clinician

  • Once you have scheduled an intake session with a specific clinician please fill out our Online Patient Information Form. If you have not yet spoken with our Intake Staff to schedule an appointment please call 508-543-2133 extension 260.

STEP 3: Fill in our Patient Intake form:

  • After an appointment/phone call with your Clinician (and as directed by your Clinician, please fill in our ONLINE PATIENT INFORMATION FORM. If you are filling in the PDF version, please print out and bring it with you on your appointment date.

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STEP 4: Read all the important information you need:

  • Kindly read the following documents below regarding the Office Policies and General Information/Consent for Psychotherapy Services, and the Financial Agreement

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STEP 5: On your appointment day, bring the following:

  • Your insurance card and any authorization and/or benefits information

  • The completed Patient Information Form, if you filled it on the PDF version. If you did the online version, you are good.

  • The name and phone number of your Primary Care Physician

  • A list of current medications

  • Insurance Verification Form

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If you have other questions, or need help in filling out forms:

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