Patient Forms

Forms (pdf) are available to preview and download.
(Adobe Acrobat Reader® is needed to view and print some of them).

If you have questions about any of these forms, please feel free to contact Whole Life Health Care, at 603-431-6677.

To download the forms, on the links below, right-click (Windows) or Ctrl-click (Mac) and choose “Save Link as…” or “Download Linked File…”

Family Practice / Primary Care

Confidential Patient Information Form
Authorization for Disclosure of Medical Information Form
Financial Policies Form
HIPAA Form
Medical Records Release Form 
New Patient Registration Form

Family Practice – Questionnaire for Medicare Patients

Welcome To Medicare Patient Questionnaire

Catherine Allen Markovsky – Acupuncture

Seacoast Acupunture Intake

Jennifer Carlson – Ayurvedic Medicine

Ayurvedic Initial Consult Paperwork

Ainslee Farrington and Rachel Willerer – Bowenwork

Bowenwork Client Intake Form

Ryan Khalsa – Chiropractic

Ryan Khalsa intake form

Jessica Kennon – Massage Therapy

Trinity Massage Intake Form

Lisa Spurling – Mental Health Counseling

Lisa Spurling Patient InformationForm

Lisa Spurling Consent form

Melissa Snow – Nutrition Therapy

Consent to Treat and Release Health Information

Pediatric Nutrition Assessment Form

Adult Nutrition Assessment Form

Ozgur Akbas – Mental Health Counseling

Informed Consent to Assume Responsibility for Payment for Psychotherapy Services
Informed Consent for Psychotherapy & Office Policies – Ozgur Akbas
Client Registration Form
Biographical Information – PARENTS to fill out
Biographical Information – Intake Form
Authorization To Release Information