Patient Forms & Info

Our staff would be happy to answer any questions or to provide you with a hard copy of any document.

Useful Forms

Release of Information for Current Patients

  • Medical patients: Fill out entire form
  • Dental patients: Initial only the second item on the list in middle of the page.

Income Info & Sliding Fee Scale Application

Annual Renewal Forms

  • Download a PDF
  • Print it out and fill it in
  • 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

Use this form to ask us to send you a renewal packet in the mail. 

  • Download a PDF in your language:
    Espanol | Portuguese | Tiếng Việt | Indonesia
  • Print it out and fill it in.
  • Mail it to your health center or drop it off:
    – Families First, 8 Greenleaf Woods Drive, Portsmouth, NH, 03801
    – Goodwin Community Health / Lilac City Pediatrics
    311 Route 108, Somersworth, NH 03878

Regardless of which option you choose:

One of the forms asks you to acknowledge that you have been given access to the following documents. Please click the links below to read them. 

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Please Understand …

We are experiencing continued staffing shortages and adjusting to a recent upgrade to our technology to serve you better. This may affect wait times and access to some services. Please be patient and kind with our staff, both on our phones and in our centers. We are doing our very best to serve you. Thank you.