Forms

Registration Form (can be completed in advance of your first visit, PDF)

Obtain Records (from any provider/institution to Dr. Zwaan, PDF)

Release Records (or exchange information from Dr. Zwaan to other provider, PDF)

Practice Policies  (an updated version is on the “about us, our practice” tab, PDF)

Private Contract (for Medicare patients. Fees on this form have changed, PDF)

Administrative Fee (needs updating. access fee now $200/$300 per year, PDF) 

HIPAA Notice (if you are interested in privacy rules, PDF)

Diabetes Journal (used at each diabetic follow-up visit, PDF)

Additional forms are available on the secure patient portal.

 

General Info

Fax: 603.658.3105

Office Location

Exeter Executive Park
19 Hampton, Road
Suite One
Exeter, NH 03833

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Hours

Mon 9:00 am – 5:00 pm
Tue 9:00 am – 5:00 pm
Wed 9:00 am – 5:00 pm
Thu Closed
Fri 9:00 am – 5:00 pm
Sat Closed
Sun Closed

For lifelong health and wellness

Same Day Appointments Available.

BOARD CERTIFIED FAMILY PHYSICIAN

SENIOR AVIATION MEDICAL EXAMINER

Give Us a Call

e-mail Dr. Zwaan

Office Location

19 Hampton Road, Suite One
Exeter, NH 03833

Secure Patient Portal

Established patients can log into the Updox portal to:

  • send and review messages
  • review reports
  • request refills and referrals
  • request, confirm or cancel appointments
  • make payments

Log into the Portal