New Patient Form

Please complete and submit the following form. This information is required before we can begin work. This form is completely secure, but if it makes you feel more comfortable, you may wish to complete the form, print it out and fax it to Dr. Conti at 860.659.4358.


If the answer to this question is YES, then call 1.800.SUICIDE or your nearest crisis/suicide hotline. If you are in immediate danger, call 911 NOW.