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Writing to Heal

New Patient Forms & HIPAA

New Patient Intake Form - To provide you with the best treatment possible, it's important for us to get to know your medical history and health goals.
*Please TEXT the completed document to (203)451-9865 IN ADVANCE or bring the completed forms to your first visit. Thank you.

Notice of Privacy Practices (HIPAA) - This notice is for your records. You don't have to bring it with you. This document describes your rights as a patient, how your medical information may be used, disclosed during your treatment, and how you can get access to your own records. We do not sell, share, distribute, rent, or profit from your confidential info.

Lateness is considered 15 mins after your appt time

Your appointment time is reserved exclusively for you. Pls let us know in advance if you cannot make your appointment so that we may offer that time to another patient. We appreciate a text if you are running 5-10 mins late. 

We Request 48 Hours Notice to Cancel or Reschedule.

It is the Patient’s responsibility to cancel or reschedule appointments. We do not guarantee appointment reminders. We respect your time at our clinic and reserve it just for you, so please respect our time and communicate with us in advance. You can text, email, or call us (203)451-9865 EST. 

Missed Appointment Fee

We charge a single session rate of $180/hr for a missed appointment. We uphold this policy for all new and returning patients. Thank you.