Free Phone Consultation: 603.718.8328
Listed below are the downloadable forms for new patients and established patients. Links to each form are provided in the “Downloadable Documents” section below. These documents are can be submitted more quickly and easily as fillable forms in the secure Patient Portal. If you have an existing Patient Portal account, please click below to log in, and go to “Forms” to submit them electronically. If you do not yet have a Patient Portal Account, please enroll and access the forms here:
Forms are available in either Microsoft Word format or in Adobe Acrobat Reader format.
Adobe Acrobat Reader is available free of charge from Adobe’s website. The current version of Adobe Acrobat Reader can be accessed by clicking on the image below.
| Form Name | Word Format | Acrobat Format |
|---|---|---|
| Check-In | (36 KB) | (126 KB) |
| COVID-19 Informed Consent to Treat | (244 KB) | (114 KB) |
| Telehealth and Telemedicine Consent | (208 KB) | (102 KB) |
| Office Policy | (49 KB) | (94 KB) |
| Information and Consent to Treat | (180 KB) | (110 KB) |
| List of Medications, Supplements, and Topical Preparations | (48 KB) | (112 KB) |
| Patient Health History Intake | (247 KB) | (336 KB) |
| PHI (Protected Health Information) Release Form | (153 KB) | (124 KB) |
| Privacy Notice Receipt Acknowledgement | (133 KB) | (70 KB) |
| Telemedicine Preparation | (515 KB) | (397 KB) |
| Notice of Privacy Practices (Read only) | (83 KB) | (127 KB) |
| Exposure Control Plan (Read only) | (71 KB) | (211 KB) |
| What to Expect When You Visit (Read Only) | (52 KB) | (111 KB) |