Registration Forms

Here you can view and download our New Patient Registration Documents. Please have these forms completed for your first appointment to facilitate registration.

 

Required Forms for Chiropractic and Physical Therapy Treatment

All New Chiropractic and Physical Therapy Patients are required to complete the following documents prior to registration:

Registration and History

Informed Consent

Dry Needling Consent

 

If any of the following apply, please complete prior to registration:

Anthem Insured Waiver (Anthem – Chiropractic patients only)

Tufts Insured Waiver (Tufts Health Plan & Freedom Plan – Chiropractic patients only)

Medicare Insured Waiver (Medicare – Chiropractic patients only)

You may view or download our HIPAA Policy here.

You may view our Appointment Policy here.

You may view or download our Notice of Privacy Practices here.

 

Workers Compensation and Auto-Injury Forms

If any of the following apply, please complete prior to registration:

Workers Compensation Questionnaire

New Hampshire Workers Compensation Medical Form

Auto Accident Questionnaire

 

 

  • Contact Us

    91A N. State Street
    Concord, NH 03301
    P: (603) 724-2297
    F: (603) 369-3017

    Request An Appointment

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