New Patient Forms

The following forms are part of the new patient registration process. Printing out the forms and completing them in advance can save you time at your first appointment.

If you need assistance with any portion of this form our Patient Service Representatives are happy to help you.

New patient intake form

All patients are required to complete this form which provides us with your basic information and consent to provide treatment.

Download New Patient Intake Form – English
Download New Patient Intake Form – Spanish
Download New Patient Intake Form – Portuguese

Learning Assessment

Completing the “What’s your Learning Style” questionnaire helps ensure we provide information and educational material in the best manner possible.

Learning Assessment Form

Personal Representative

A personal representative is someone you authorize to be involved in your health care. If you would like to authorize health center staff to speak with a spouse or another individual regarding your health care we will need to have this form completed. This includes conversations such as rescheduling appointments or questions on billing issues.

Personal Representative Form

Transfer Your Records to Us

In order to provide you with the best care possible, our providers need access to your past medical history.

If you have not requested to have your medical records transferred to us, complete this form and return it to the health center. Our Medical Records department will work with your previous provider to transfer the records.

Release to Obtain Records Form

FAQs

What are your hours?

Nashua:
Monday – Thursday: 8:00 am to 7:00 pm
Friday: 8:00 am to 6:00 pm
Saturday: 9:00 am to 12:00 noon

Newmarket:
Monday – Thursday: 8:00 am to 7:00 pm
Friday: 8:00 am to 5:00 pm
Saturday: 9:00 am to 12:00 noon

Raymond:
Monday – Thursday: 8:00 am to 7:00 pm
Friday: 8:00 am to 5:00 pm
Saturday: 9:00 am to 12:00 noon
Sunday: 9:00 am to 4:00 pm (closed from 12:00-1:00 for lunch)

Sunday hours are available to all Lamprey Health Care patients at the Raymond Center.

How do I get my prescriptions refilled?

The simplest way for request a refill is through the secure patient portal MY HEALTH. You can also request a refill by calling the health center and selecting option #2.

Allow 1 week for all refill requests.

New prescription requests must be made through an appointment with your provider.

What if I don’t have health insurance?

All patients are welcome at Lamprey Health Care – whether you have health insurance or not.

You may be surprised to find that you qualify for reduced rate insurance or other coverage programs. Our Certified Application Counselors are available to review your specific situation and can help you determine if you are eligible for coverage.

We have a variety of options to make sure you get the health care you and your family needs, including payment plans and a sliding fee discount program. Please visit the Financial Assistance section for more details.