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DIAGNOSTIC COAGULATION CENTER Outpatient Consultation Referral Form Phone: (603) 6506763 Fax: (603) 6506786 Referring Provider: Patient Name: Name of Guardian/Parent if 18yo: Office Phone: DOB: Office.

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Dartmouth Hitchcock Medical Center (DHMC) in Lebanon—New Hampshire's only academic medical center—includes a 396-bed (licensed) hospital, with the only Level I Trauma Center and Level II Pediatric Trauma Center, and the only air ambulance service (DHART) in New Hampshire.

Our program is the only trauma center in New Hampshire to earn a Level One Trauma Center verification signifying that our physicians, nurses, and administrators provide the highest level of injury care.

Patient care facilities at Dartmouth Hitchcock Medical Center include a 396-bed general hospital and extensive outpatient clinics, providing primary, secondary, and tertiary health care to residents of northern New England.

Dartmouth Hitchcock Clinics Concord Monday through Friday: 8 am to 4 pm (walk-in hours for patients ages 6 months and up). Saturday and Sunday: Closed. Walk-in urgent appointments are available at Dartmouth Hitchcock Clinics Manchester for patients ages 2 and up (8 am to 5 pm).

Fax: 603-676-4080 for routine referrals, note requests, or status checks.

Dartmouth Hitchcock Medical Center is the state's only academic medical center and the only Level I Adult and Level II Pediatric Trauma Center in New Hampshire.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232