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Patient Forms

Download and complete forms to bring/send ahead of time.

Patient Symptom Summary

*for use when another person will be bringing your child to an appointment and you want to inform the office or your concerns*

Consent for Non-Parent to Bring Minor Child to Appointments

*for use when another person will be bringing your child to an appointment and you want to authorize them to do so*

Records Release - Transfer Out Of Office

Records Release - Release to Exchange Information

18+ Consent Packet

New Patient Packet

Initial ADHD/ Vanderbilt Questionnaire

Follow-Up ADHD/Vanderbilt Questionnaire

Hampton Office​

55 High Street STE 102 Hampton, NH 03842

Phone: 603-929-3838

Fax: 603-929-0655

Hours

M-F 8:00am - 5:00pm

Sat *closed*

Sun *closed*

Weekend hours are in the Portsmouth office only for all patients to utilize for emergencies

Portsmouth Office​

330 Borthwick Ave STE 101 Portsmouth, NH 03801

Phone: 603-436-7171

Fax: 603-433-5931

Social Media

Hours

M-F 8:00am - 5:00pm

Sat 8:00am - 12:00pm 

Sun 8:00am - 12:00pm 

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