If you cannot print and sign the form, please specify in your email message exactly what information you are requesting. Be sure to include your name, date of birth and a phone number where we can reach you. Fax to: 631-447-3077 Attn: HIM Dept. If you any questions, please do not hesitate to call us at 631-654-7710. Main campus. Texas County Memorial Hospital 1333 S. Sam Houston Blvd. Houston, MO 65483. Toll-free: 1-866-967-3311 Local: (417) 967-3311. Freeman Hospital. Tel: 0191 233 6161 Address: Freeman Road, High Heaton, Newcastle Upon Tyne, Tyne and Wear, NE7 7DN Website: http://www.newcastle-hospitals.nhs.uk/.

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