Familial Cancer Program

Referral Form

Please submit this form to refer your patient to Dartmouth Cancer Center Familial Cancer Program. In-person visits are offered at our Lebanon and Manchester locations. Referrals are processed through the Manchester office listed below.



Dartmouth Cancer Center Manchester

Notre Dame Pavilion, Catholic Medical Center

87 McGregor Street

Manchester, NH 03102

Phone: 603-653-3541

Fax: 603-727-7814


Norris Cotton Cancer Care Pavilion, Lebanon

Dartmouth Hitchcock Medical Center

One Medical Center Drive

Lebanon, NH 03756

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Please attach all documents related to this visit request such as office notes, pathology reports, lab reports.

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