This registration form is required annually to ensure that your demographic information is current in our system. Please use this version if you are an existing patient at our practice.
DownloadThis form is required to give us permission to obtain or release protected health information.
DownloadThis form is completed and signed by patients who would like to authorize another individual the ability to discuss the patient’s healthcare needs with our staff or providers. This form is optional and needs to be renewed every 12 months.
DownloadThis form is used to gather important health information from adults.
DownloadThis form is used to gather important health information from youth.
DownloadPlease choose this version if you are visiting a primary care practice located in New Hampshire.
DownloadPlease choose this version if you are visiting a primary care practice located in Maine.
DownloadWentworth-Douglass Hospital
789 Central Avenue
Dover, New Hampshire 03820
Phone: (603) 742-5252
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