Record Release Form

Please see below for information regarding transfer or records to and from our practice…

1. You are NEW to the practice and need to OBTAIN your records from a previous provider please complete and send to prior office.
2. You are LEAVING the practice and need to RECEIVE your records from Family Health Matters please complete and return to our office along with $15.00 payment.*
3. You are a CURRENT patient and need to request/give permission for specialists/facilities to SEND records please complete and return to our office.

*Records fee only applies when leaving the practice or to obtain a copy of full records as an existing patient. New patients do not need to pay a records fee to join the practice.

DOWNLOAD RECORD RELEASE FORM

pay $15 records fee here

Payment Options

Having trouble reading/understanding your bill? Questions? please email billing@fhmatters.com OR text 603-386-0100

32 Stiles Rd Suite 103, Salem, NH 03079

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