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
Medical Records Release Form
New Patient Registration Form

Family Practice – Questionnaire for Medicare Patients

Welcome To Medicare Patient Questionnaire

Jennifer Carlson – Ayurvedic Medicine

Ayurvedic Initial Consult Paperwork

Christina Barrows, Krista Connolly 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

Adult Nutrition Assessment Form
Pediatric Nutrition Assessment Form
Digestive Health History