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On-Line Registration Code Request Form

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Note to Concord Hospital Employees: It is our policy that you do not use your work email address for Patient Connect.

Please provide us with a phone number where we can reach you between 8:00am - 5:00pm Monday - Friday in the event we have any questions.



Your request will be processed within 24 hours Monday through Friday until 3pm (excluding holidays). Please be sure to check your email spam/junk folder if you have not received a reply from us within 24 hours.

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