New Patients

Welcome new patients, to your Medical Home.

New Patient Forms

These 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 visit.

If you need help with any portion of these forms, our Patient Service Representatives are happy to help you.

patient receiving paperwork

New Patient Forms

New Patient Intake Form

All patients must complete this form. It gives us basic information and consent to provide care.

Patient Intake Form - English

Patient Intake Form – Spanish

Patient Intake Form – Portuguese


Release to Obtain Records Form

This required form allows us to request records from your previous healthcare provider. If you do not have a prior healthcare provider, please let us when scheduling your first appointment.

Release to Obtain Records Form


Personal Representative Form

A personal representative is someone you authorize to be involved in your health care. Complete this form if you want to allow our staff to speak with a spouse or another individual regarding your health care. This includes conversations such as rescheduling appointments or questions on billing issues.

Personal Representative Form


Learning Assessment Form

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

Learning Assessment Form - English

Learning Assessment Form - Spanish

Learning Assessment Form - Portuguese


Financial Assistance Application

If you are uninsured, you may qualify for our financial assistance program. Please complete this application to see if you are eligible. If you have questions, please ask to speak with a Certified Application Counselor.

Financial Assistance Application – English

Financial Assistance Application – Spanish

Financial Assistance Application – Portuguese


Parental Consent Form

Parents or guardians, please complete this consent form to allow providers at Lamprey Health Care to provide your child or ward care when you are not present.

Parental Consent Form

lamprey health booklet cover

New Patient Information Booklet

When you come to the office for your first visit, you will receive our New Patient Information Booklet. This booklet contains helpful information on our practice and is updated annually. Below are the most recent editions available for download.

2019-20 New Patient Booklet - English

2019-20 New Patient Booklet - Spanish

2019-20 New Patient Booklet - Portuguese

Transfer Your
Records to Us

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. Return it to us, and our medical records department will work with your previous provider to transfer the records.

Release to Obtain Records Form

medical record folders

New Patient FAQs

What are your hours?


Our hours have changed as we respond to the COVID 19 pandemic. As of November 29, 2022, our hours are:

Nashua:
Monday – Friday: 8:00 am to 5:00 pm
Wednesdays:  2:30-5:00 pm, Teen Clinic

Newmarket:
Monday – Friday: 8:00 am to 5:00 pm

Raymond:
Monday – Friday: 8:00 am to 5:00 pm

How do I get my prescriptions refilled?


The simplest way to 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 one week for all refill requests.

Request new prescriptions 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 Navigators and Certified Application Counselors are available to review your situation and can help determine if you’re eligible for coverage.

We have a variety of options to make sure you get the health care you and your family need. This includes payment plans and a sliding fee discount program. 

insurance

No Insurance?
No Problem.

You will never be turned away because you don’t have insurance.
portal

MY HEALTH Online Patient Portal

Access information and request services, all through one easy to use site.
newsletter

Receive Our Newsletter

Our caring professionals work as a team to create your Medical Home.