If you have questions or are having access problems, please call the Dartmouth-Hitchcock Physician Connection Center.
- CHaD Pediatric Specialties Referral Form (PDF)
- Electroencephalography (EEG) and Evoked Potential Request Form (PDF)
Manchester Pediatric Neurology referral form
Referral forms are standard for all pediatric specialty services with the exception of sleep studies in Pediatric Neurology in Manchester. Please use the following specific form.
Complex Primary Care Appointment/Transition of Care form
Visit the Dartmouth-Hitchcock Manchester Referrals page to download the Complex Primary Care Appointment/Transition of Care Request form.
For additional forms, visit the Referral Forms page on the Dartmouth-Hitchcock website.