Patient Forms

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

Patient Intake Packet

Patient Treatment Contract

Explanation of Treatment

Consent to Release & Receive Information

Acknowledgement of Receipt of HIPAA

Drug Abuse Screening Test

Appointment Cancellation Policy

Informed Consent of Buprenorphine

Psychotherapy Form

HIPAA Notification

Benzodiazepine Management Agreement

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.