Please download and fill-out our Patient Registration Form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Patient Registration and History Form
Call us at West Lebanon Office Phone Number 603-643-5730 if you have any questions about these forms.
Technical Note: You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.
Lebanon NH • Hanover NH • Lyme NH • Woodstock VT • Norwich VTWhite River Junction VT