Arcara - Home Page
617-431-6140
264 Beacon Street Boston, MA 02116 / 300 West Main Street Building B Northborough, MA 01532

First Visit Intake Form

Give Cindy, our Practice Manager, a call at 857-301-9842. You may leave a voicemail and she will call you back as soon as possible. You may also fill out our online intake form below which will be sent directly to Cindy.

**We do not treat anyone under the age of 14.**

Email/Internet Privacy Notice: I understand that any information sent from this website is not encrypted and therefore my privacy cannot be guaranteed while it travels on the internet. While unlikely, I accept that a breach of my privacy could occur when sending this information over the internet and/or when communicating by email and I am willing to accept that risk. I also understand that I have the option of calling the office so that I may leave this information on Cindy's voicemail.

yes no  * Required

***Please note that the caller ID may not say our company name***


yes
no

Private Pay (Check, Mastercard, Visa)
BU Student Health Plan
Blue Cross/Blue Shield
Blue Cross/Blue Shield - Out of State


Medication Management
Psychiatric Evaluation
Depression
Stress Management
ADD/ADHD
PTSD
Insomnia
Anxiety
Conduct Disorder
Schizophrenia / Schizoaffective Disorder
Substance Abuse
Addiction Disorder (Alcohol, Opiod, Internet, Sexual, Gambling, ect)
Anger/ Irritability
Eating Disorder
Sleep Disorder
Bipolar Disorder

Headaches
Other chronic pain
High Blood Pressure
Cardiac Problems
Diabetes
Neurological Condition
Back or neck pain
Obesity
High Cholesterol
Gastrointestinal Problems
Sleep Apnea or Other Sleep Problems
Asthma/Respiratory Problems
Other
I do not have any medical conditions


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First Visit

You must set up a phone call with Cindy. She will call you during the hours you select on the form.

Hours

Our hours are 8:30am - 4:30pm. Screenings and appointments must be made during these hours.