446A Blake Street
New Haven, CT 06515
FAX (203) 245-0572
Refer To Waterstone Addiction Medicine
Please Fill Out The Short Form Below, FAX a Referral or Call Us
If you would like to refer a patient to Waterstone or have an inquiry, you may call, fax or electronically submit the form below and we will follow up with you as soon as possible. To protect privacy, this form has safeguards in place. However, submission of this form electronically via our web site is not technically HIPAA compliant so we are unable to guarantee the security of any personal identifiable information you submit at your own discretion. For this very reason the form has been crafted to acquire only the most generic and basic information required for contacting you and/or your patient.
Thank you! Your submission has been recorded. Please Assist Patient with Secure Intake Form below
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