Hematology
New Patient Referral Form
Please submit this form to refer your patient to Dartmouth Cancer Center for a second opinion, consultation, treatment, or follow-up care at the following locations:
Dartmouth Cancer Center
Hours: Monday through Friday, 8 am to 5 pm
Phone 603-650-6272
Fax 603-727-7814
Norris Cotton Cancer Care Pavilion, Lebanon
Dartmouth Hitchcock Medical Center
One Medical Center Drive
Lebanon, NH 03756
Phone: 603-653-3500
Dartmouth Cancer Center Manchester
Notre Dame Pavilion, Catholic Medical Center
87 McGregor Street
Manchester, NH 03102
Phone: 603-629-1828
Dartmouth Cancer Center Nashua
Dartmouth Hitchcock Clinics Nashua
2300 Southwood Drive
Nashua, NH 03063
Phone: 603-577-4170
Dartmouth Cancer Center St. Johnsbury
1080 Hospital Drive
St. Johnsbury, VT 05819
Phone: 802-473-4100
Fax: 802-473-4109
After provider review, some appropriate referrals may be changed to E-consults to expedite response time.
HEMATOLOGY E-CONSULT DISCLAIMER
E-consults are based on the clinical data available to the reviewing provider and are furnished without benefit of a comprehensive evaluation or physical examination. All advice and recommendations must be interpreted in light of any clinical issues, or changes in patient status, not available to the reviewing provider. The ongoing management of clinical problems addressed by an e-consult is the responsibility of the referring provider. If you have further questions or please contact the reviewing provider. If needed, the patient will be scheduled for an in-office consultation.
URGENT REFERRAL DISCLAIMER
Urgent referrals are scheduled following provider review. If your patient has a medical emergency, please direct them to the emergency room for emergent care. After hours/on-call 603-650-5000/request the on-call provider be paged