New Patient Information

Home » New Patient Information

Becoming a Patient:

To become a new patient at our practice, please print and complete all patient forms below and mail or fax them to the New Patient Referral Team. You may also drop them off at any ROAD to a Better Life office location. The New Patient Referral Team will attempt to reach you within 3 business days of receiving your paperwork to discuss the status of your registration.

This is not a guarantee of an appointment.  Please ensure you leave a good contact number, your voicemail is set up and not full.

 

What to Expect at your First Visit:

 

Drug Use Requirements:

You must be in withdrawal (dope sick) to start bupenorphine/naloxone (Suboxone) or bupenorphine.

To ensure this:

  • Methadone must be discontinued 72 hours prior to starting bupenorphine/naloxone (Suboxone) or bupenorphine.
  • Heroin must be discontinued 12 hours prior to starting bupenorphine/naloxone (Suboxone) or bupenorphine.
  • Oxycontin, Morphine, Vicodin, Percocet must be discontinued 24 hours prior to starting bupenorphine/naloxone (Suboxone) or bupenorphine.

 

Group therapy Program:

Our 24-week Group Therapy Program is required for patients prescribed bupenorphine/naloxone (Suboxone).

Read more about our group therapy here:

Group Therapy

 

Patient Responsibilities:

Treatment for addiction is a two-way street – active participation is paramount to your success.

Here’s what we expect from you:

  • To attend AA or NA 12-step recovery program and/or individual therapy
  • To be on time for weekly and monthly office visits.
  • To be honest.

 

Billing:

Payment is expected at time of service. We accept most major insurances, including Medicare, Medicaid and major credit cards. No personal checks are accepted. Only bank drafts/money orders or cash.

New Patient Referral Team:

255 Route 108
Somersworth, NH 03878
Ph: 603.841.2307
Fax: 603.692.1070

New Patient Forms:


New Patient Forms

You may also review our Notice of Privacy Practices, which explains how we use your health information. Thank you for choosing ROAD to a Better Life.

Call us at 603.841.2307 to request information or send us a message below.

 

Email Warning:
This email communication is not secure. Please refrain from including personal or health information when using this form. If you would like us to contact you, please provide the phone number you would like us to use. Thank you.


Name:*
E-mail:*
Phone Number:*
-
Message:


By hitting "Submit" I understand and consent to this e-mail communication