Insurance referral forms (to see a specialist or receive a service)
to ensure that we have been able to process them correctly with your insurance company. Insurance that requires a referral please fill out and return this form: General Referral Form.
Please submit ALL information on this form by printing the above document and faxing it to 603-642-6701, dropping it off or Emailing it to [email protected] with ALL the information completed. Failure to complete may result in a delay of your referral and causing you to have to pay for your specialist visit.
Established Medical Patient Registration Update Form (when there has been a life change)
Our lives ebb and flow and with that comes changes. If you have had any changes to your name, address, phone number, insurance or your emergencey contact information please fill out a new REGISTRATION FORM or MEDICARE REGISTRATION FORM and MAIL it back to us.
New Counseling Client Form
If you are a new counseling client and have been asked to fill out forms before your arrival to your first appointment, please click HERE to access that document.
Medical Release Form (to have a copy of your records sent somewhere)
Effective July 1, 2021 New Creation Healing Center will provide their last 5 years of medical records, including immunizations record and most recent colonoscopy ONE TIME ONLY free of charge to transferring patients. We recommend that you have this copy of your record sent to you (rather than your new provider) so that you can make a copy for your new provider. Patients may request their entire chart or additional copies at the current allowed rate. Please fill out our MEDICAL RELEASE FORM and submit it to our office. Allow 30 days for your request to be completed.
If you are a current patient of the practice, and are not leaving our practice, but you need some or all of your records released to another entity (insurance company, research study, etc) and that entity has not asked you to sign a medical release form please fill out our MEDICAL RELEASE FORM and submit it to our office.
Therefore, if anyone is in Christ, he is a new creation; old things have passed away; behold, all things have become new. 2 Corinthians 5:17