Becoming a Families First Patient
Thank you for considering Families First for your health care needs, and welcome! Please follow the instructions on this page if:
1) You want to become a
Families First Health Center patient. The Health Center is open to everyone -- men, women and children; infants to seniors; insured or uninsured, all income levels. We provide primary care and prenatal care. (Questions? Call 603-422-8208, press 1)
2) You want to enroll your child or teenager as a
Families First Dental Center patient. The Dental Center is open to all children and teens living in New Hampshire or Maine. Adults must first be established primary-care or prenatal patients at Families First before using the Dental Center. (Questions? Call 603-422-8208, press 3)
Please print out the forms by following the links below, or call us at 603-422-8208 (press 1) and ask to have them mailed to you. Also, feel free to call anytime if you have questions.
- Paperwork for primary care and dental care
- Paperwork for prenatal care
- If you are uninsured ...
- On your first visit
Paperwork before scheduling a Primary Care or Dental appointment
- Primary Care/Dental Intake Form (3 pages). Note: The form asks you to sign a statement that you have read and understand the documents on pages 16-27 of the Patient Handbook, which you will find here.
- Copy of Medicare, Medicaid or insurance card, if you have this coverage. (We can photocopy for you.)
- Copy of SeaCare card if you have one. (We can photocopy for you.)
- If the new patient is an uninsured child, we require a completed NH Healthy Kids application. Click here to get the application, or call 603-422-8208 ext. 142 for a hard copy of the application and/or assistance completing the application.
For help filling out paperwork, call 422-8208 ext. 142.
Paperwork before scheduling a Prenatal appointment
- Prenatal Intake Form (11 pages). The form asks you to sign a statement that you have read and understand the documents on pages 16-27 of the Patient Handbook, which you will find here.
- Copy of Medicaid or insurance card, if you have this coverage. (We can photocopy for you.)
For help filling out paperwork or other questions, call 422-8208 ext. 142.
We are happy to offer a sliding fee scale, based on income, to patients who are uninsured or underinsured. (Note: If you later become insured, we hope you will remain a patient at Families First. Families First is here to serve both insured and uninsured patients.) To apply for a sliding-fee discount, please provide the following:
- Sliding Scale Application
- Proof of all types of income that you and your spouse receive, including salaries and wages, Social Security, retirement, business, welfare payments, child support, alimony, disability and any others. For each type of income, submit one of the following:
- Current tax return
- Unemployment check stubs; or
- Schedule C (Profit & Loss from Business)
For help filling out paperwork, call 422-8208 ext. 142.
Please mail the paperwork back, or drop it off at Families First anytime the Health Center is open (Mondays, Tuesday, Thursdays and Fridays from 7:30 a.m. to 5 p.m., and Wednesdays 7:30 a.m. to noon and 1:30 to 5 p.m.) After we receive your paperwork, we’ll schedule your first appointment. We will also tell you the amount of your sliding fee scale payment if you applied for the sliding fee scale.
- Please arrive 10-15 minutes early to finalize paperwork.
- Bring your copayment if you have insurance that requires one, or your sliding fee scale payment if you are using our sliding fee scale.
- Be prepared to pay additional fees for tests, injections or other services that you may receive during your visit.
