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New Patient Forms

As a new patient to the Upper Valley Natural Health Center, you will need to completely fill out our age-appropriate New Patient Form prior to your first appointment. This is a lengthy form, so please set aside at least 30 minutes to fill it out.

  • For telemedicine visits: please return your completed form to us, along with a copy or photo of your health insurance card and vaccination card, if applicable.

  • For in-office visits: please bring your completed form, your health insurance card, your vaccination card, and a bag with all of your prescription, over-the counter, and natural medicines.

Important Practice Information and Policies

We also ask that you carefully review our Welcome Letter prior to your first visit. This letter explains in detail how our practice operates to provide you the best possible care and service, including our office policies regarding billing, email and phone call consults, and our natural medicine dispensary.

Sending Medical Records

If you wish to have specific results forwarded to Dr. Chollet before your appointment, you may complete our Medical Records Release Form and give it to the appropriate physician, practice, or hospital. Please do not send your entire medical records. Typically she prefers to review most recent labs and any imaging reports that pertain to your complaint, such as an upper endoscopy report.
NOTE: Dr. Chollet has provider access to electronic medical records at Dartmouth Hitchcock Medical Center, Alice Peck Day Hospital, and Mt. Ascutney Hospital. For your convenience, you may provide your permission for her to review your records electronically.

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