An official website of the United States government

Here's how you know

Official websites use .mil

A .mil website belongs to an official U.S. Department of Defense organization in the United States.

Secure .mil websites use HTTPS

A lock () or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

DoW Forms Management Program

FORM INFORMATION

Form Number: DD 2871

Title: Request to Restrict Medical and Dental Information

Edition Date: 12/01/2003

For use of this form please contact: The Defense Health Agency (DHA)