Become A Patient

Becoming A Patient:

To become a new patient at our practice, please print and complete all patient forms below and mail or fax them to the New Patient Referral Team. You may also drop them off at any ROAD to a Better Life office location. The New Patient Referral Team will attempt to reach you within 3 business days of receiving your paperwork to discuss the status of your registration.

This is not a guarantee of an appointment.  Please ensure you leave a good contact number, your voicemail is set up and not full.

You may review our Notice of Privacy Practices, which explains how we use our health information. Thank you for choosing ROAD to a Better Life.

Records Release Forms:

New Patient Forms:

This information may be dropped off at any of our locations, mailed to our office (See locations page here) or faxed to (603) 692-1070

Call us at (603) 841-2307