We need some information to grant you a myDH account. After you submit this request, it may take up to a week for processing and verification. When you're approved, you will receive an email or a letter with your activation code and instructions on how to activate your myDH account. If you have any questions, please contact us at 603-650-0499.

I hereby affirm that I am the patient identified below. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this application to access the myDH service.

I acknowledge that I am signing up for paperless billing and will receive notification of new billing statements through email.

*If you wish to opt out of paperless billing, you may do so by logging into your myDH account and clicking on Billing, then Account Summary. Click on the link "cancel paperless billing" and confirm that you want to receive paper statements.

I hereby affirm that I am the patient identified below. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this application to access the myDH service.

I acknowledge that I am signing up for paperless billing and will receive notification of new billing statements through email.

*If you wish to opt out of paperless billing, you may do so by logging into your myDH account and clicking on Billing, then Account Summary. Click on the link "cancel paperless billing" and confirm that you want to receive paper statements.

I hereby affirm that I am the patient identified below. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this application to access the myDH service.

I acknowledge that I am signing up for paperless billing and will receive notification of new billing statements through email.

*If you wish to opt out of paperless billing, you may do so by logging into your myDH account and clicking on Billing, then Account Summary. Click on the link "cancel paperless billing" and confirm that you want to receive paper statements.

Complete the missing information below to finish signing up for a myDH account.

If you have any questions, please contact us at 603-650-0499.