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

New Patient Forms

***As of July 2019 we are only taking new patients for our NH Cannabis certification program  and BioTE Hormone Optimization Program.  We are happy to place you on a waiting list for Primary care and Women's health if you would like to fill out forms and send them in.

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 an appointment when one is available. We look forward to seeing you soon!

-Intro to Practice

-Patient Registration

-Health History

-General Info

-Liability Waiver

-Permission to Share Info

-HIPAA Acknowledgement

-Financial Policy

Records Releases and Requests

Here are our record release / request


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