Patient Forms

After selecting the appropriate forms, please print and fill out forms PRIOR to your scheduled appointment. Thank You!

Consent to Release & Receive Information

Forms

Consent To Treatment

Forms

PHI Policy

Forms

PHI Acknowledgement

Forms

Patient Questionnaire

Forms

Telehealth Patient Form

Forms

Service Region

Waterstone Counseling Centers serve New London, New Haven and Middlesex Counties, Connecticut. The medication component of our MAT program requires a regional service area, however, our unique Integrated Psychotherapy services are available to a non-local community through telehealth solutions and our interactive education platform.