Become a Prenatal Patient at our Community Health Centers

Please fill out this short form. After you submit it, the New Patient Coordinator will call you or email you within 2-5 business days. You are also welcome to call (603) 749-2346 ext. 2535.

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Your Name*
Please use this space to write questions or notes for the New Patient Coordinator. If you are already a patient, please use the Patient Portal to contact your health care team or the office staff, or call us.
Which language do you prefer to speak with your health care team?*
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Mailing Address
Have you ever been a patient at Goodwin Community Health, Families First Health Center or Lilac City Pediatrics in the past?*
This field is for validation purposes and should be left unchanged.
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