Siracusa Associates Behavioral Health
77 Hosptial Ave Suite 214
North Adams, MA 01247
Click the bottom for the Intake Packet.
Please read everything carefully. These forms cannot be completed online. Please print them and fill out all forms completely and bring them with you to your first appointment. Having these filled out before you arrive will expedite the administrative portion of your visit. Also, if you don't have a copy of your insurance card, please have your card with you so we can make a copy for your file.
The "Patient Information" portion of the packet is for you to keep and read carefully. Enclosed in that portion is important information regarding your rights, important insurance information, and HIPPA regulations.
Please click on the PDF below to open the intake packet for printing.