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 choose one of these ways to complete the paperwork to become a new patient. You can also find links to paperwork translated into Espanol, Indonesia, Tiếng Việt and Người Bồ Đào Nha). Our staff would be happy to answer any questions or to give you a paper copy of any document. 

Use this form to send a question to our staff

Option 1: Register online (preferred) 

  • Register online for Families First Health Center or Goodwin Community Health
  • Online registration is not available for Lilac City Pediatrics. See below for how to register on paper.

Option 2: Download a PDF, print it out, fill it in and send it back. 

  • Download intake packet here. This packet is for Families First, Goodwin Community Health, and Lilac City Pediatrics. After filling in the forms, mail them to New Patient Coordinator, Greater Seacoast Community Health, 311 Route 108, Somersworth, NH 03878.

Option 3: Ask us to mail the paperwork to you.

  • Use this form to ask us to send you an intake packet in the mail. 

One more thing to do if you are becoming a patient at Lilac City Pediatrics …

For Lilac City Pediatrics, 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.

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

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. 

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:

Helpful Links and Info for Patients