New Patient Registration Forms

Now that you have a scheduled appointment with us, we need some additional information

Please download, complete and send the New Patient Information Form to us before your first appointment.

For primary care appointments, please return your completed form by one of the following methods:
  • Fax: 603-580-6644
  • US Mail: 7 Holland Way, Exeter, NH 03833
  • Dropbox: at 7 Holland Way, Exeter, NH 03833
All remaining forms will be presented to you, as needed,  as part of our online registration & appointment check-in process. It is important you complete the online check-in process before every appointment!
If you do NOT have a cell phone or email address, please print and complete the below forms and bring with you to your first appointment.

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. (Please enter: New Patient Welcome Center, 7 Holland Way, Exeter, NH in the To field for primary care appointments).