Commonly Requested Forms

Due to a high volume of new patient requests, please note that our dental capacity for new patients is limited. To inquire about becoming a new patient of Mid-State’s Dental Clinic, please call our office at 603-744-6200.

Medical Patient Forms

Dental Patient Forms:

New Patient Package

Physical Therapy:

Behavioral Health:

New Patient Package
BH Informed Consent

RISE Recovery Patient Forms:

Other Forms:

Patient Consent to Permit Health Information Sharing between Mid-State and:

Speare Memorial Hospital

Dartmouth-Hitchcock Medical Center