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387 Lake Road

Suite 3

Saint Albans, VT 05478

802-527-2225

New Patient Forms

Back to Health offers our New Patients forms online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader�® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.


This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Adult Patient Health History Forms- Required (All Patients 13 & Older)

Download & Print Form

New Adult Medicare Patient Health History Forms - Required (All Patients with Medicare as Primary Insurance)

Download & Print Form

New Child Patient Health History Forms - Required (All Patients 12 & Under)

Download & Print Form


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Monday:

8:00 am - 12:00 pm

1:30 pm - 5:30 pm

Tuesday:

7:30 am - 12:00 pm

1:30 pm - 5:30 pm

Wednesday:

8:00 am - 12:00 pm

1:30 pm - 5:30 pm

Thursday:

7:30 am - 12:00 pm

1:30 pm - 4:00 pm

Friday:

8:00 am

1 pm

Saturday:

Closed *Emergencies seen.

Sunday:

Closed *Emergencies seen.