Medical Records Release forms for Doctors Bennett, Fitzgerald, 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, you will need to release your medical records to Derry Medical Center. (Releasing your medical records as soon as possible is especially important if you have current prescriptions that will need refilling in January or February.)

Please be assured that we will continue to work closely with the Elliot Health System, and you will still be able to use the Elliot, Catholic Medical Center, or any other hospital system for both your inpatient and specialty care. Many of your initial questions may be answered in this Frequently Asked Questions page.  You can also Learn more about Derry Medical Center.

Medical Records Release

Electronic Version:  For the quickest and easiest way to ensure a seamless transition of your care, please click the first link below to open the electronic DocuSign form for Release of Medical Records.

Electronic Medical Release Form.

Paper Version:  A paper version of the form can be found in the link below. This form can be printed and dropped off to their current office, or mailed to the Elliot Hospital, ATTN: Medical Records Dept., One Elliot Way, Manchester, NH  03104

Paper Release of Medical Records Form.

The staff at Derry Medical Center are available to answer questions and schedule appointments by calling 603-537-1300.