Here you will find a variety of patient forms that can be opened then printed by clicking on each link.


New Patient Forms

Please start with the "intro to practice" form which outlines what you will need and how to proceed. Once we have had a chance to review you information we will then reach out to get you scheduled. We look forward to seeing you soon!

-Intro to practice

-Patient Contact

-Health History

-General info

-Liability Waiver

-Permission to share info

-HIPPA Acknowledgement

-Financial Policy


Records Releases and Requests

Here are our record release / requests. Any records created in 2018 or before are legally part of My Friend's Gynecologist and Primary Care for billing purposes and you will need the bottom form to transfer those records to CFH computer system by 2019. The top form is used for current requests.

-Release to RECEIVE : SEND RECORDS

-Record release from MFG&PCW to CFH  (needed if a patient before 2019)


NH Therapeutic Cannabis

Below are the NH Therapeutic Cannabis applications. All patients applying for certification will need the top form and the rest of the forms are required only if you plan to have a caregiver buying / dispensing for you because you are unable.

-TC Patient Application

-TC Caregiver Application

-Caregiver Attestation Form

-TC Criminal Records Form for Care Givers