Before you make your first purchase with us, we require a few pages of intake paperwork. You can either print them out and bring them with you on your first visit, or you can fill them out in the lobby at your first visit.
New Hampshire Patients
Please fill out page 1 and 2 the following NH Patient Intake Form. The agreements and acknowledgements that correspond to the signature on page 2 are found at the end of the document.
Patients Visiting from Out-of-State and Canada
Please fill out page 1 and 2 of the Out-of-State Patient Intake Form. The agreements and acknowledgements that correspond to the signature on page 2 are found at the end of the document.
There is also an OPTIONAL Out-of-State Medical Provider Form if you qualify under NH regulations and would like your medical provider to allow you more then 3 visiting with in a years’ time. Dual state residency would be a good example of why you may need this form.
