MAKE AN APPOINTMENT

Information Needed:

You can make an appointment here, or you can call our main number at 617-266-2266 ext.131

If you leave a message on our answering service, we will return the call within 24 business hours. When making an initial appointment it is helpful to have just a few pieces of information.

We will ask you for:

* Your insurance information – Please see insurance we accept.

* Times when you are available

* What services you are seeking – individual therapy, couples therapy, medication evaluation, medication management

* A brief description of why you are seeking therapy

You are also welcome to read about our therapists and include their name under “Anything Else” on this web intake form.

Schedule An Appointment

To schedule an appointment, this form MUST be filled out completely. You will receive a confirmation from our intake coordinator.

Appointment Intake Form

Name: (As spelled on insurance card) (Required)

Email: (Required)

Phone: (Required)

Brief description of why you are seeking therapy:

I am interested in: IndividualCoupleMedication

Days and times you are regularly available:
Appointments after 5:00 PM fill up quickly, so it is best to include a few choices.
You will increase your chance of a quicker appointment with more flexibility.
Rasi Associates is not open for business on Saturday or Sunday.

Insurance Company: Please see insurance we accept above.

Insurance ID Number:

Date of Birth:

Behavioral Health or Provider Phone Number: found on back of insurance card

Anything else that would be helpful for us to know:

When done, please press the Finish button.

Copyright 2019 Rasi Associates
607 Boylston Street, Boston, MA 02116 • 617 266 2266
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