Following is a list of 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.

 

***PATIENTS OF DR. AJAY KOSHY, WELCOME TO DMC!***

TO FILL OUT AND SUBMIT YOUR RELEASE OF MEDICAL RECORDS FORM, PLEASE CLICK HERE:  Authorization Form for Use and Disclosure of Protected Health Information_DR KOSHY

***PATIENTS OF DR. HOWARD SULS, WELCOME TO DMC!***

TO FILL OUT AND SUBMIT YOUR RELEASE OF MEDICAL RECORDS FORM, PLEASE CLICK HERE:  Authorization Form for Use and Disclosure of Protected Health InformationDR_SULS

Release of Medical Records Form:

Other Forms for All Patients: