Referral Instructions – Milestone Mental Health (Medication Management)
To refer a patient for medication management services at Milestone Mental Health, please complete the referral form provided. We will contact your patient within 1–2 business days.
Release of Information: Please have your patient complete a Release of Information form for:
Nancy Gallagher, APRN Milestone Mental Health 36 Country Club Road, Unit 924 Gilford, NH 03249 Phone: (603) 697-7228 Fax: (603) 208-0916
Clinical Documentation: Please fax the following documents to (603) 208-0916:
Current medication list
Most recent clinical note
Recent lab results
Copy of ROI
Any other information you feel is important for continuity of care
If you would like to discuss the referral directly, I am happy to set up a time to speak. Please feel free to contact me.
