Forms

Please select the forms below you would like to download. If you are coming in for your first visit with Dr. Miller, the first three forms would be the most useful to fill out. If they are received before hand, they will be reviewed prior to your visit.

You can either scan and email your forms to drmiller@thelunacenter.com, fax them to (603)590-6318, or send by mail to 10 Strawberry Dr, Ste 9 Dover NH 03820. You can also arrive 20 minutes early to your appointment to fill out your paperwork at The Luna Center for Natural Health.

Email your forms to: frontdesk@theluncenter.com

Thank you!

Attachment Size
Medical Records Release Form 512 KB
Treatment Consent Form 92 KB
Patient Information Form 119 KB
Appointment Cancellation Policy 27 KB
Adult Intake Form 70 KB
Pediatric Intake Questionnaire 45 KB
Notice of Privacy Practices 39.68 KB