Helpful Links & Info for Established Patients

Release of Medical Information …  online … or … PDF (to print)

Pay Bill Online

Income Info & Sliding Fee Scale Application 

Annual Renewal Paperwork

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. 

Please do this to complete your annual patient paperwork:

Option 1: Complete forms online (preferred) 

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

  • Download a PDF, print it out, and fill it in.
    English | Espanol | Indonesia | Tiếng ViệtNgười Bồ Đào Nha
  • Mail it to your health center or drop it off:
    – Families First, 8 Greenleaf Woods Drive, Portsmouth, NH, 03801
    – Goodwin Community Health, 311 Route 108, Somersworth, NH 03878
    – 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: