Patient Forms & Info

Our staff would be happy to answer any questions or to provide you with a hard copy of any document. Give us a call at the  numbers shown at the bottom of the page.

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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