Patients can download forms by clicking the following links:
- Patient Registration
- Medical History
- HIPAA Privacy
- Acknowledgement of HIPAA Receipt
- Diet for 3 Hour Glucose Test
- Instructions for Pelvic Ultrasound
- Instructions for Sonohysterograms
- Instructions for Obstetrical Ultrasound
- Release of Medical Records
- Patient Financial Policy w/ Signature
- Patient Financial Policy
- No Show Policy
Our fax number is 603-924-8709.
For billing questions, please call 603-924-3088.
We accept the following forms of insurance:
- CHN PPO Consolidated small group
- Coventry Health Care National Network
- Mail Handlers
- First Health
- Harvard Pilgrim
- First Health Network
- Maine Community Health
- Martin's Point
- Multi Plans/PHCS Network
- Tufts Health Plan (Freedom Plan) and Tufts Carelink (not Tufts HMO)
- United Health Care
- Medicaid (Xerox)
- Humana (Medicare Plan)
- NH Healthy Families
HMO patients need a referral for all visits excluding annual well woman exam and pregnancy.
If you have a question regarding our office participation with your insurance plan, please call our office at 603-924-3088.