Become a Patient:
Who can use this program?
We are accepting new pediatric patients (up to age 17). New-patient slots for adults are currently limited. Please call (603) 422-8208 (press 4) for more information.
What should I do first?
- If you have a printer, you may fill out this Patient Intake Form (pdf). Or you may ask us to mail you one.
- Read these pages from our Patient Handbook (.pdf)
- Print and sign the form.
- Mail or bring the form to:
100 Campus Drive
Portsmouth, NH 03801
If you have questions, call 603-422-8208 (press 4)
If you have insurance, call 603-422-8208 (press 4) to schedule your appointment. If you don’t have insurance, once we have processed your sliding scale application, we will call you to schedule your first appointment. When scheduling, let us know if you will need child care or translation.
Arrive 5-10 minutes early to finalize paperwork. Bring your forms if you haven’t mailed them in. Ask for a Patient Handbook.
Bring a list of the medications you take, or the actual medications.
Bring your insurance copayment or sliding-fee scale payment.