New Patient Information

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Becoming a Patient:

To become a patient and to be added to our waiting list, please print and fill out all patient forms below and 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 3-5 business days of receiving your paperwork to discuss the status of your registration.  This is not a guarantee of an appointment.

 

What to Expect at your First Visit:

  • Paperwork
  • Brief Physical Exam
  • Urine Drug Screen
  • Same Day Prescription (In most cases)

 

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:


Notice of Privacy Practices
Patient Registration Health History Treatment Agreement
Record Release Authorization
Record Release Authorization – Criminal Justice
Permission to Discuss  

 

New Patient Paperwork for Vivitrol Treatment:


Notice of Privacy Practices
Patient Registration Health History Treatment Agreement
Record Release Authorization
Record Release Authorization – Criminal Justice
Vivitrol Permission to Discuss            

 

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

 

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