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CLIENT FORMS

For Direct Online HIPAA Compliant Submission of Paperwork

CLIENT INFORMATION FORM

For All New Clients

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PAST MEDICAL HISTORY

For All New Clients

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CONSENT TO TREATMENT

For All Manual Therapy Clients

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Roots Integrative Therapies in Portsmouth, NH

Contact Us

(603) 205-9966

155 Brewery Ln, Suite 103
Portsmouth, NH 03801

welcome@rootsnh.com

(603) 956-3069 (fax)

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