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

Please answer all the questions below so that we can best address your concerns. Someone will be in contact with you from our clinic within 2 weeks.

Currently we are limiting our practice to the following New England States: MA, NH, VT, CT, RI and ME. 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.

ALSO PLEASE NOTE THAT WE DON’T TAKE ALL INSURANCES SO IF YOU ANY QUESTIONS PLEASE CONTACT YOUR INSURANCE COMPANY.

Thank you!

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