Please follow the two-step process to becoming a patient:

1. Download and complete the following form:



2. Next, scan and email or mail the form back to:


255 South Champlain Street, Burlington, VT 05401


3. Once we receive your paperwork we will call you to schedule an appointment.

Note: If you do not have access to a printer we will mail you a copy.

Please call our office with any questions: (802) 489-7745

We look forward to working with you!