Here’s everything new patients need to do to help prepare for their first appointment.

Complete the new patient form:

Submit the following completed forms:

Download the appropriate forms to print and complete before your visit: 

• Adults’ Brain Injury Vision Symptom Survey Form
• Childrens’ Quality of Life Checklist Form
• HIPAA Consent to Treat Form
• Record Release Form
• Third Party Payment Form (Workers’ Comp)
• Payment Authorization Form
• Missed Appointment & Financial Agreement Form

Additional medical records can be emailed to admin@inspirevisionnh.com
Or FAX to 603-410-4102

Gather the following to submit in person:

• Driver’s license or photo ID
• Medical insurance card
• Glasses or contact lens prescription
• Your completed forms from list above

For workman’s compensation cases:
If your exam is part of a workman’s compensation case, you must also provide:

• Claim adjuster name and contact information
• Claim number
• Date of injury
• Nurse or case manager name and contact information

Arrive on time!

We have a 15-minute late policy. Please plan to arrive 15 minutes before your appointment so we can get you started on time. If you are more than 15 minutes late for your appointment, you may be asked to reschedule for another time.