Lilac Natural Medicine - Dr. Michelle Haff - (603) 707-4433
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  • About Dr. Haff
  • Naturopathic Medicine
  • What We Treat
    • Pediatric Health
    • Women's Medicine
    • GI Health
    • Mental Health
    • Endocrine Health
    • Fertility Services
  • Services & Therapies
    • Naturopathic Care
    • Acupuncture
    • Fertility Services
    • Telemedicine
  • New Patients
    • Schedule an Appointment
    • What to Expect
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Forms

New Patient Forms
New Patients: Please complete all new patient questionnaires through the patient portal. When you scheduled your initial appointment, you should have received an email inviting you to create an account on the portal. Do not print and complete these forms unless you cannot complete them through the portal.
Adult Initial Intake
File Size: 243 kb
File Type: pdf
Download File

Pediatric Initial Intake
File Size: 229 kb
File Type: pdf
Download File

Policies and Financial Agreement - Electronic Communication Agreement - Informed Consent to Naturopathic Services
File Size: 214 kb
File Type: pdf
Download File

Notice of Privacy Practices
File Size: 248 kb
File Type: pdf
Download File

COVID-19 / Telemedicine Consent
File Size: 98 kb
File Type: pdf
Download File

Other Forms
Records Release
File Size: 51 kb
File Type: pdf
Download File

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​​Lilac Natural Medicine

170 S. River Road
Bedford, NH 03110
Phone: 603-707-4433
​Fax: 888-652-3587

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©COPYRIGHT 2023
​LILAC NATURAL MEDICINE, LLC
​​​ALL RIGHTS RESERVED.
  • Home
  • About Dr. Haff
  • Naturopathic Medicine
  • What We Treat
    • Pediatric Health
    • Women's Medicine
    • GI Health
    • Mental Health
    • Endocrine Health
    • Fertility Services
  • Services & Therapies
    • Naturopathic Care
    • Acupuncture
    • Fertility Services
    • Telemedicine
  • New Patients
    • Schedule an Appointment
    • What to Expect
    • Insurance and Fees
    • Forms
    • Testimonials
  • Contact Us
    • Schedule an Appointment
    • Patient Portal
    • COVID-19
  • Order Supplements
  • Media & More
    • Events
    • Blog
    • Newsletter