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Sharon Rousmaniere
CHC
Keene, NH
(603)357-8928

   


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If you're interested in finding out more about how we can help you - or would like to schedule a free consultation, please use the form below to contact us.
   
Name:
Address:
Phone:
E-Mail:
   

Comments / Questions?

Phone: (603) 357-8928

Essential Health / Nutrition and Wellness Counseling
155 Washington Street
Keene, NH  03431

Fax: 1-775-898-8838

info@essentialhealthcounseling.com

 
 
 


 

 

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New Clients

Please complete a Health History Form prior to your initial consultation.

Click on the appropriate form below. It will be sent to you via email as an MS Word document. Please fill it out on your screen and return it as an email attachment.

Women's Confidential Health History

Your Email  

Men's Confidential Health History

Your Email  

Returning Clients

Please complete a Revisit Form at least 24 hours prior to each appointment.

Click below to fill out a Revisit Form. It will be sent to you via email as an MS Word document. Please fill it out on your screen and return it as an email attachment.

Revisit Form

Your Email  

If you would prefer to print out the forms to fax or mail them to me, please click below for printable versions:

ESSENTIAL HEALTH
Nutrition and Wellness Counseling
PO Box 373 / Keene, NH  03431 / Ph: (603) 357-8928 / FAX: (775) 898-8838 sharon@essentialhealthcounseling.com

Need Adobe Reader? Click on the icon to download the file.

 
 

2015 Essential Health Counseling, LLC