Patient Forms

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

Patient Intake Packet

Forms

Patient Treatment Contract

Forms

Explanation of Treatment

Forms

Consent to Release & Receive Information

Forms

Acknowledgement of Receipt of HIPAA

Forms

Drug Abuse Screening Test

Forms

Appointment Cancellation Policy

Forms

Informed Consent of Buprenorphine

Forms

Psychotherapy Form

Forms

HIPAA Notification

Forms

Benzodiazepine Management Agreement

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.