Following are forms you may need as a DMC Primary Care patient. If you have questions or are looking for information not listed here, please call us at 603.537.1300. Our Medical Records main fax number is 603.537-1355.
NEW PATIENT PACKET (ALL DOCUMENTS):
Please CLICK HERE to fill out all documents in the NEW PATIENT PACKET electronically.
INDIVIDUAL FORMS:
Medical Records Release Forms:
- Electronic Version: Medical Release of Information Form
- Printable Version: Medical Release of Information Form
DMC Patient Code of Conduct Forms:
DMC Consent for Non-Parent/Guardian to Accompany a Minor to Medical Appointment:
DMC Financial Policy:
DMC General Consent for Treatment:
DMC No Show Policy:
DMC Notice of Patient Privacy Practices
Notice of Patient Privacy Practices
DMC Personal Information Release:
Electronic Version: Personal Information/Permission to Speak
Printable Version: Personal Information/ Permission to Speak
DMC Preventative Health Visits – Scope of Insurance
- Electronic Version: Preventative Health – Scope
- Printable Version: Preventative Health Visits – Scope