Option 1: Click on the button below to Download the form. Then, print and fill out the form. Please bring the completed form to your first appointment or mail it to:
Maureen Linsenmeir
22 Pleasant Avenue
Burlington, VT 05408
Option 2: Click on the button below to download the form. Then, fill out the form on your device (using your default pdf viewer) by tapping in each field. Finally, email the completed form to me at: