Please read these instructions before filling out this intake form!

Hi! Welcome to the Pediatric Psychiatry OCD and Tic Disorders Program clinical intake form.

Before filling out the form, please call MGH Registration at 866-211-6588 to obtain a Medical Record Number (MRN). We cannot complete the intake process without an MRN.

Please answer all the questions below so that we can determine how to best address your concerns.

Someone will be in contact with you from our clinic as soon as we are able to review the form, typically within 2-3 weeks of submission.


Please note that we cannot treat PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) or PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) in our clinic

For PANDAS/PANS, please contact Mary Spencer at the Pediatric Neuropsychiatry and Immunology Program at 617-724-0198 or

This program does not currently offer behavioral talk therapy.

Patients must reside in one of the following New England States: MA, NH, VT, CT, RI and ME.

Please note that we do not take all insurance plans so please be thorough with the full name of your insurance company and plan.

If you have any questions, you can send an email to!

Thank you!

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