Welcome New Patients

Thank you for choosing Wentworth Health Partners Coastal Neurology Services.

Patients must be referred by their primary care provider or another provider involved in their care. Medical information pertaining to referrals can be faxed to our scheduling dedicated fax number at (603) 749-4858.

In addition, please complete any requested and return them to us prior to your first appointment. 

Frequently Requested Forms

• Patient Registration Form
• Current Health History
• Sleep Questionnaire
• Patient Review of Systems

Additional Forms

When you arrive for your first appointment, please bring: 

• All of your health insurance cards
• Photo identification (current driver’s license, employee badge or military identification card) or two forms of alternate identification that include your name and address (such as utility or phone bills or lease agreement). For minors, acceptable forms of photo identification include a wallet-sized photo, school identification card, military identification card, or if accompanied by a parent, the parent’s photo identification. 
• All medications you are currently taking, including vitamins and over the counter medications. This will ensure your medication list is accurate and current with dosages and dosing instructions.

Please note, when using a GPS unit for directions to our office, please enter Somersworth instead of Dover to ensure you arrive at the correct location.

If you have any questions, please call our office at (603) 749-0913.