Please be sure to read these instructions before starting to fill 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 two weeks of submission.

Please be aware that our primary long-term treatment modality is psychopharmacology, or medication management. If you are not interested in learning about or pursuing medication options, then we will not be able to provide long-term care! We are happy to do one-time evaluations for diagnosis or second-opinion purposes.

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

Please note that we do not take all insurance plans, so if you have any questions, please contact your health insurance company or send an email to MGHPediOCDTics@partners.org.

Thank you!

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