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Are you asking for Patient Portal assistance for yourself or someone else?
Please provide your date of birth (MM/DD/YYYY). 
Enter patient name and contact information
Please provide the patient's date of birth (MM/DD/YYYY).
Please provide the date or date range of the appointment(s).
What was the purpose of the appointment?
Please provide details about why you are contacting us. 
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I understand that this is a general contact form and a medical diagnosis cannot be determined from this communication. Information contained in this transmission will not be directly received by a physician and does not automatically create a patient-provider relationship. I further understand that communications submitted over the internet may not be secure and that I am voluntarily including any personal health information herein. I also give Newton Healthcare Corporation (doing business as NMC Health) permission to send any and all of my information to the proper contact to assist with my needs, and give NMC Health permission to contact me directly via email or phone in response to this submission. This form is only applicable to NMC Health locations and facilities.
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