New Patient Registration Forms

Begin your new patient registration by downloading and completing the forms below

You can fax the below forms to our new Patient Welcome Team at 603-580-6644. You may also drop them off at your Core Physicians’’ PCP’s office prior to your first appointment. Please bring your current insurance and prescription card to your first visit.
 

Notice of Privacy Practice
New Patient Information (Registration) Form
General Outpatient Consent Form
Race/Language/Ethnicity Form
Acknowledgement of Receipt of Privacy Practices
Personal Health Information Disclosure Agreement
Electronic Communications Consent Form

Other Forms (as needed)
Authorization to Treat a Minor When Unaccompanied by Parent/Legal Guardian
Authorization to Release Protected Health Information to Core Physicians  - to obtain a copy of your non-Core practice/provider medical record