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330 West 58th Street, Suite 207
New York, NY 10019
Tel: 212.944.8444
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1000 Herrontown Road
Princeton, NJ 08540
Tel: 609-497-0433
map provided by maps.google.com
CONFIDENTIAL
New York Office: (212)-944-8444
New Jersey Office: (609)-497-0433
IMPORTANT: All information you provide on this form is kept strictly confidential. Your information will not be added to any mailing list or passed on to any other individuals or organizations.
Your Private Consultation with
Dr. Washton
You will be seen personally by Dr. Washton for the initial consultation to evaluate your drinking patterns and formulate an individualized treatment plan. Once you have set up your appointment with Dr. Washton, please download, print out, and fill out the New Patient Questionnaire and bring this form with you to the appointment.