Intake Paperwork

If you would like to become a new patient, please fill out the Pre-Screening Questionnaire below. We will review it and determine if NENH is a good match for your needs. NENH staff will then contact you to either schedule an initial consultation or give you suggestions for referrals. If NENH is a good match for your needs, you will be asked to please fill out the intake paperwork listed below.

NENH requests that you submit your paperwork prior to arriving at the office for your Initial Consultation. Filling out the form will take you a minimum of 15 minutes and detail is welcome. Please remember to sign the Consent for Treatment and initial each item of the Payment Policy. Scheduled new patients, please bring in your past two years of lab work either prior to your initial appointment or upon checking in for your initial appointment at the office.

All new patients are required to pay the Initial Consultation fee of $275 at the time of booking their appointment. *Please note that payment for the first appointment only is due at the time of booking.

Pre-screening Questionnaire


Pediatric Intake Paperwork

Electronic Pediatric Intake Paperwork

Adult Intake Paperwork

Electronic Adult Intake Paperwork

Medical Record Release Form

Nutrition Intake Paperwork