Forms and Patient Information

If you are a new patient for WLHC Primary Care services, please bring all new Patient Paperwork (New Patient Demographic Form, Financial Policy, No show/ cancelation Policy, HIPPA Notification Form, Authorization to Speak/ Release Information and Primary Care Physician Waiver).

Please read Our HIPPA Privacy Notice.

If you would like to request your medical records from previous providers, feel free to use Our Release of Medical Records Form.

If you are seeing one of our Integrative Providers, please bring there specific New Patient Intake Forms to your first visit.

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

	WLHC Family Practice / Primary Care     (New Patients Please Print All Documents) - New Patient Demographic Form   - Financial Policy   - No Show/Cancellation Policy   - HIPPA Privacy Notice   - HIPPA Notification Form   - Authorization to Speak/Release Information   - Release of Medical Records   - Primary Care Physician Waiver       *********************************************************   Integrative Providers Intake Forms:   (New Patients Please choose applicable forms for the provider you are going to see)
	Ayurveda for Life  with Jennifer Carlson - New Patient Intake Form (Health Information Form)
	Ayurveda for Life  with Jennifer Carlson - New Patient Intake Form (Body Typing)
	Ayurveda for Life  with Jennifer Carlson - New Patient Intake Form (Statement of Understanding)
	Massage Therapy Jessica Kennon  (Trinity Massage) - New Patient Intake Form
	Mental Health Counseling with Lisa Spurling - New Patient Letter to Parents/Guardians
	Mental Health Counseling with Lisa Spurling - Adult New Patient Information Form
	Mental Health Counseling with Lisa Spurling - Consent to Treatment Agreement
	Natural Health Intuitive and Energy Medicine with Hilary Crowley -  New Patient Intake Form
	Nutrition Therapy with Melissa Snow - Adult New Patient Intake Form
	Psychotherapy with  Deborah Emery - Gigliotti, MS, LCHMC, Mindful Healing
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