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We ask all new clients to please print and fill this form out completely. You may either scan it, or take pictures of it with your phone, and email it back to us at harmony@harmonypsychiatric.com at least 24 hours prior to your first appointment. If we do not have a complete form, we will reach out and ask to reschedule your first appointment.

There are times when your Harmony provider may need to collaborate with other professionals to provide you with the best care possible. Your provider will discuss this with you before doing so, explain your rights, and will ask you to complete this form. If they do, please print and fill this form out completely. You may either scan it, or take pictures of it with your phone, and email it back to us at harmony@harmonypsychiatric.com

22 Stiles Rd. Salem, NH 03079           (603) 475-8322            harmony@harmonypsychiatric.com

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Harmony Psychiatric Services © 2021  |  All Rights Reserved

All intake packets must be completed 24 hours prior to your first appointment. This is to ensure timely processing of your request by our staff.


Please call us at (603) 475-8322 or email us at harmony@harmonypsychiatric.com if you have any questions.