Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Dover Pediatrics, PLLC before sending sensitive documents. FaxFlow is not affiliated with this organization.
Dover Pediatrics, PLLC fax number
(603) 743-3345
Behavioral Health
Used for: Medical records release / transfer (PHI) communications to/from Dover Pediatrics
Fax destination details
- Department
- Behavioral Health
- Purpose
- Medical records release / transfer (PHI) communications to/from Dover Pediatrics
- Form
- Record Release Form — Dover Pediatrics Record Release Form
- Address
- 17 Old Rollinsford Rd., Ste 5, Dover, NH 03820
- Voice phone
- 603-742-4048
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Authorization to release protected health information. Fill requester name, patient, recipient, purpose (transfer from/to Dover Pediatrics), and PHI to be released (medical and/or billing records; date range if applicable). Sign and date; indicate method of delivery. The form notes that it becomes effective immediately and expires one year from signature; photo ID may be required to pick up records.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.