Patient Information Request Form

Getting Started

Thank you for your interest in becoming a patient, or for being a patient already! You can use this form to request intake paperwork and/or ask a question.

To get started, please choose the practice you are interested in (Families First in Portsmouth, Goodwin Community Health in Somersworth, or Lilac City Pediatrics in Rochester).

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We will have a delayed opening at 9:15am on Wednesday 9/14/22

We will have a delayed opening at 9:15am on Wednesday 9/14/22

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