Forms
Membership Agreement
This is the contract that you will be agreeing to if you decide to join this office.
Hearthside Health History Form- Please feel free to print and fill out, however we will review all of this at your first visit.
Privacy Notice- You do not need to print. When you sign up, it will ask that you have reviewed this. Please review the document and click YES during registration.
Hearthside Record Release Authorization, Word document
This is a release of information to receive previous records, or disclose records to another practice. You may submit a release of records to your previous provider OR with us and we can submit that release in order to obtain your medical records for review.
Hearthside Record Release Authorization, PDF form
This is a release of information to receive previous records, or disclose records to another practice.
Hearthside Family Health
109c Grove Street
Peterborough, NH 03458
phone (603) 312-1600
fax (603) 371-2629
