Online Patient Pre-registration

To help insure accuracy and save time, you can pre-register HERE online before arriving for your first appointment. The information, including your medical history is transferred to our secure servers using a HIPAA compliant protocol to protect your personal information.

You may also print out the registration form and medical history and fill it out beforehand, then bring it to the office on your first visit.

It is our goal to make the registration process as convenient as possible for you.

After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature.


For more information about our practice or to schedule a consultation with Dr. De Tolla, call our office in Portsmouth, NH at Portsmouth Office Phone Number  603-436-3608.