Patient Information and Documents

Thank you for your interest in becoming a patient at Families First, Goodwin Community Health or Lilac City Pediatrics. Let’s get started!

Getting Started as a New Patient

Please click the arrow next to the name of the health center where you would like to become a patient. There, you will find contact information for each health center and links to our intake paperwork (in English, Espanol, Indonesia, Tiếng Việt and Người Bồ Đào Nha). Our staff would be happy to answer any questions or to provide you with a hard copy of any document. 

Please choose one of these ways to complete the paperwork to become a new patient:

  1. Click this link to register online (preferred)
  2. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Families First, 100 Campus Drive,  Portsmouth, NH, 03801. 
    English | Espanol | Indonesia | Tiếng ViệtNgười Bồ Đào Nha
  3. If you need information mailed to you, use the form on this page to request it.

What’s next?

Once we receive and process your paperwork – this takes 7-10 business days – we will contact you to schedule your first appointment. 

Bring to your first appointment:

  • A list of the medications you take, or the actual medications
  • Your insurance cards, co-payment or sliding-fee-scale payment

If you ever find that you can’t keep an appointment or will be late, please call to let us know. 

Please choose one of these ways to complete the paperwork to become a new patient:

  1. Click this link to register online (preferred)
  2. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Goodwin Community Health, 311 Route 108, Somersworth, NH 03878.
    English | Espanol | Indonesia | Tiếng ViệtNgười Bồ Đào Nha
  3. If you need information mailed to you, use the form on this page to request it.

What’s next?

Once we receive and process your paperwork – this takes 7-10 business days – we will contact you to schedule your first appointment. 

If you ever find that you can’t keep an appointment or will be late, please call to let us know. 

Please choose one of these ways to complete the paperwork to become a new patient:

  1. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Lilac City Pediatrics, 180 Farmington Road, Rochester, NH 03867.
    English | Espanol | Indonesia | Tiếng ViệtNgười Bồ Đào Nha
  2. If you need information mailed to you, use the form on this page to request it.

Request your child’s medical records from their previous or current pediatrician. Ask the provider to mail the records to: 
Lilac City Pediatrics, 180 Farmington Road, Rochester, NH 03867. 

Wait one week after your provider has sent the medical records and you have sent in your application, then call us at 603-335-4522 to schedule your child’s first appointment.

If you ever find that you can’t keep an appointment or will be late, please call to let us know.

We look forward to meeting your family!

One of the forms asks you to acknowledge that you have access to these documents, which you may read by clicking these links:

Annual Paperwork for Established Patients

Please scroll down to find the paperwork that we ask all patients to complete annually. Our staff would be happy to answer any questions or to provide you with a hard copy of any document. Contact information for staff at each health center is below. 

Please do this to complete your annual patient paperwork:

  1. Click this link to complete online (preferred)
  2. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Families First, 100 Campus Drive,  Portsmouth, NH, 03801.  
    English | Espanol | Indonesia | Tiếng ViệtNgười Bồ Đào Nha

Please do this to complete your annual patient paperwork:

  1. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Goodwin Community Health, 311 Route 108, Somersworth, NH 03878.
    English | Espanol | Indonesia | Tiếng Việt | Người Bồ Đào Nha
  •  

Please do this to complete your annual patient paperwork:

  1. Download a PDF, print it out, fill it in, and mail it to us or drop it off at Lilac City Pediatrics, 180 Farmington Road, Rochester, NH 03867.
    English | Espanol | Indonesia | Tiếng Việt | Người Bồ Đào Nha

One of the forms asks you to acknowledge that you have access to these documents, which you may read by clicking these links:

Forms for Patients

Helpful Links and Info for Patients