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New Patient Forms & Information

To save time on your initial visit, please print and fill out the following forms before your appointment. Otherwise, we ask that you  arrive 15 minutes prior to your scheduled appointment time to fill out necessary paperwork at the office. Please feel free to contact our Front Desk if you have any questions or concerns.

 

Digital Intake for all ages (submit through computer, smart phone, or tablet)

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                             (submit digitally)

             

               (print or sign in office)

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Paper Forms age 11 and older

 

 

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Paper Forms age 10 and younger

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For review only:

 

Office Notice of Privacy Practices - HIPAA 

 

 

White Mountain Chiropractic & Rehabilitation
Portsmouth, NH chiropractor, Rindge Chiropractor, New Ipswich Chiropractor
Portsmouth, NH chiropractor, Rindge Chiropractor, New Ipswich Chiropractor

New Ipswich Office

5 Dark Lane - New Ipswich, NH 03071 - Tel  603.878.5387

Rindge Office

1102 Route 119 - Rindge, NH 03461 - Tel  603.899.5153

Portsmouth, NH chiropractor Rindge Chiropractor, New Ipswich Chiropractor, Jaffrey Chiropractor, Winchendon Chiropractor, Peterborough Chiropractor, Greenville Chiropractor, Fitzwilliam Chiropractor, Troy Chiropractor, Keen Chiropractor, Milford Chiropractor, Gardner Chiropractor

Portsmouth Office

140 Edmond Ave - Portsmouth, NH 03801 - Tel  603.899.5153

© 2022 White Mountain Chiropractic & Rehabilitation

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