There are 4 steps which are required to fulfill the request:

1. Fill out a Patient Data Request Form
2. Email Patient Signature Page to Koha
3. Koha staff fulfills request

REQUEST FORM: Hit Continue and you will be directed to fill out a form to be processed by the Koha Health Team.

EMAIL PATIENT SIGNATURE: Please email the patient signature page to ATTORNEYREQUESTS@KOHAHEALTH.COM with the subject “Attorney Request”.

KOHA FULFILLS REQUEST: A Koha Health team member will securely email you the requested information within 3-5 business days.

If you have any questions during the process, please contact us at 603-673-9411.