Please download and complete the QHHS Patient Referral Form and submit via Fax or Email per below.  We are happy to take this information directly over the phone or through email as well.

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Intake Email :

Intake Fax: 603-552-5302

Intake Phone: 603-552-5300

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Please do not hesitate to call us directly with any questions concerning new patient referrals or the referral and intake process.  

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Thank you!

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Insurance - NH Medicaid, Commercial,  LTC Insurance and Private Pay patients accepted

 

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