Make a Referral

Our aim is to make the patient referral process simple and effective for our referring providers.

The easiest way to make a referral is to download the Comprehensive Breast Program Referral Form (PDF, 143k). After filling out the form, fax it to (603) 653-3502. You can also receive a referral form by calling the program office at (603) 653-3500 and they can fax or send you a copy.

Your office will be asked to fax us the patient's relevant records and reports, and to have original mammogram films and reports plus pathology slides and reports sent to us.

For more information, call (603) 650-3500.
Or email: comprehensive.breast.program@hitchcock.org