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

1. Payment
2. Fill out the Patient Data Request Form
3. Email Patient Signature Page
4. Koha staff fulfills request

PAYMENT: Koha Health charges a fee of $20 for each Certified Letter request. Please click your desired payment method below.

REQUEST FORM: Upon a successful payment, 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. However, ALL payment and requests will need to be made through this payment and form process.