ALL patients are seen at our Portsmouth office on Saturday and Sunday for sick visits from 9-12 am

Offices:

Hampton

603.929.3838

55 High Street
Suite 102
Hampton, NH 03842

Portsmouth

603.436.7171

330 Borthwick Avenue
Suite 101
Portsmouth, NH 03801

Authorization to Disclose Health Information

A patient‘s chart becomes their property at the age of eighteen and no unauthorized individual may access that chart without express written permission of the patient. If a patient wishes to allow access to their information by another person, parent or other, they must complete the following document specifying that person may receive the information.

We encourages each person to read the document in it’s entirety before signing. Once signed the authorization will remain in effect until withdrawn by the patient.

Authorization to Disclose Health Information