New Patient Forms
Welcoming you to your new Medical home! Lamprey Health Care is committed to providing you with exceptional medical care. Below you’ll find all the information you need as one of our new patients.
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.
Welcome to Lamprey Health Care!
We are excited to provide excellent medical care for you. We partner with Simple Interact (see below for FAQs), a completely secure and comprehensive forms service.
Here is what to expect before your visit:
Before your first visit, you will receive a New Patient Forms Request after booking your New Patient appointment. Please complete these forms as soon as possible.* We can start prepping your chart ahead of time to make your visit as smooth as possible.
If you are a returning patient, you will receive a Digital Check In Request the day before your appointment. Please complete this as soon as possible.* We can start prepping your chart ahead of time to make your visit as smooth as possible.
New Patient Intake Form
All patients must complete this form. It gives us basic information and consent to provide care. You will receive an electronic Patient Intake Form electronically.
2024 Patient Intake Form English
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.
Personal Representative Forms (add or cancel)
- 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 - Complete this form if you want to cancel a previously designated Personal Representative.
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
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
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.
No Insurance? No Problem.
You will never be turned away because you don’t have insurance.
Lamprey Health Care Patient Portal
Access information and request services, all through one easy to use site.
Do you have a Personal Representative?
You can authorize other people to be involved in your care. These people are personal representatives.
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.
New Patient FAQ's
What are your hours?
Our hours are:
Nashua:
Monday – Friday: 8:00 am to 5:00 pm
Wednesdays: 2:30-5:00 pm, Teen Clinic
Newmarket:
Monday – Thursday: 8:00 am to 7:00 pm
Friday: 8:00 am to 5:00 pm
Raymond:
Monday – Thursday: 8:00 am to 7:00 pm
Friday: 8:00 am to 5:00 pm
How do I get my prescriptions refilled?
REFILLS: The simplest way to request a refill is through the secure Patient Portal. Allow one week for all refill requests.
NEW: Request new prescriptions through an appointment with your provider.
TRANSFERS: If you need a prescription transferred to another pharmacy, contact either the current pharmacy or the new one to start the transfer process.
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 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. Learn more about financial assistance.
Where can I find your health center policies including my Patient Rights and Responsibilities?
Patient Rights and Responsibilities as well as other health center policies, can be found here: Health Center Policies
What is SIMPLE INTERACT?
Simple Interact is a mobile-friendly front office automation platform that provides patients with easy access to forms, delivered directly to your device. You can complete your forms anytime and anywhere at your convenience.
Why am I getting an email/text to complete forms?
Through Simple Interact, we have automated what information we need from you and when, so that you never have to complete unnecessary forms. We only ask for what we need when we need it.
I do not like giving my personal information digitally. How can I be sure that it is secure?
Simple Interact is 100% compliant with HIPAA law and regulations. You can be sure that every page, every answer is seen only by your provider and the necessary medical support staff.
I am not a new patient, so why am I getting a request to complete forms?
The request you received from Simple Interact is a Digital Check In, which retrieves your previously recorded information for review. By completing this ahead of your appointment, you are greatly reducing your check in process for your appointment tomorrow. Give your future self a break!
Do I have to download an app or manage yet another portal username and password?
For the Simple Interact forms, the link is securely delivered to your device. You only need to go through a simple authentication process and you will have access to your forms.
English is not my preferred language, Do you have translations of the forms?
Excepting the legal forms, all forms have a language setting in the supper left corner to make the language more convenient for you.