Patient Forms

Here is a list of forms you may need as a Derry Medical Center patient. If you have questions or are looking for information not listed here, please call us at 603.537.1300. You can also check our Medical Links & Information page for general information.

Click on this link to submit the Electronic DMC Medical Release Form electronically.
Patients of Doctors Bennett, Fitzgerald or Rosenbaum:

If you are a current patient of Dr. Bennett, Dr. Fitzgerald or Dr. Rosenbaum, and wish to continue to be a patient at their new office located at 160 S. River Road, Bedford, NH 03110, please select the link below to complete an electronic Medical Release form Release of Medical Records Form for Bedford Commons Practice patients