Stoughton Counseling Intake Form – Verify Insurance & Book Therapy

PATIENT INTAKE & VERIFICATION

Welcome to Your Personalized Care Intake

Completing this initial form securely initiates your intake process for insurance verification. Once our team confirms your coverage details, a patient coordinator will reach out directly to schedule a dedicated session with our clinical team.

Next Step: Complete your details below · Verification typically takes 24–48 hours

SIMPLE 3-STEP PROCESS

What Happens Next

A clear, supportive path designed to connect you with the right clinician without unnecessary delays.

01

Complete the form

Take about 2-5 minutes to share your basic details, care preferences, and health goals securely.

02

Insurance verification

Typically 24-48 hours. Our administrative team contacts your carrier directly to confirm all benefit details.

03

Schedule session

We reach out directly by call or text to finalize your appointment time with a matched licensed therapist.

Before you start: This intake takes about 2-5 minutes. Please have your insurance card and basic contact details ready.

Patient Information

Full Name

Gender

Female Male

Patient Age

Phone *

Email *

If patient is under 18 years of age, enter guardian information below.

Guardian Name

Guardian Phone

Insurance Information (if using insurance for coverage)

Insurance Number (if using insurance for coverage)

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By checking this box, I consent to receive non-marketing text messages from Stoughton Counseling, Inc. about setting up an apointment. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out. By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others.from Stoughton Counseling, Inc. at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

Having trouble? Call (781) 975-2185 or email [email protected] and we will help you complete your intake.

HELP & CLARITY

Before You
Start

Once the intake is completed, our team will reach out to schedule you with a clinician who matches your specific goals and preferences.

How long does the form take?

Completing the intake questionnaire typically takes between 2 to 5 minutes. We keep questions straightforward so you can finish quickly without unnecessary paperwork.

What information do I need before starting?

You will only need your basic contact details, your primary health insurance card (member ID and group number), and a brief summary of what you would like to work on in therapy.

How long does insurance verification take?

Our billing team processes and verifies insurance coverage within one business day. We will confirm your estimated co-pay and deductibles prior to scheduling your initial session.

Do you offer self-pay if my plan is out of network?

Yes. We offer transparent self-pay rates as well as detailed superbills that you can easily submit to your insurance company for potential out-of-network reimbursement.

Do you offer telehealth and in-person sessions?

We provide both confidential HIPAA-compliant telehealth appointments and in-person sessions at our office, allowing you to choose the format that fits your weekly routine.

What if I am in crisis or need urgent help?

Our intake form is intended for outpatient counseling. If you or someone you know is experiencing an immediate psychiatric emergency, please dial 911 or go to the nearest emergency room.