Refer a Patient

Pulmonary Rehab
Refer a Patient—For physicians
What is required for a complete referral to CMC’s pulmonary rehabilitation program?
  • Physician referral / Physician clearance form 
  • Pulmonary Diagnosis
  • Most recent H&P and other pertinent medical information
  • Recent EKG within 6 months 
  • Recent PFT within 2 years 

Where can I find the physician clearance form to sign?
Click here to download a referral form, please sign and fax to: 603.665.2449.

You can call also call: 603.665.2545 and the Pulmonary Fitness team will facilitate. 


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