Please Call: 603-433-3636

Forms & Policy

Dear Patient:

The staff of Lafayette Family Care welcomes you to our Family Practice. We appreciate your choosing us to care for your healthcare needs.

Enclosed you will find the following important information:

In order to provide you better care and save you time at your initial visit, please complete the following as much as you can before your scheduled appointment:

  1. Please request your medical records from your previous provider as soon as possible, and have their office fax your records to us one week before your scheduled appointment. You may use our form of Authorization for Release of Medical Records and mail it to us after completed.
  2. Take the time to fill out the Patient Registration Form and Medical History prior to your visit and bring them in with you. If you are unable to complete them, please arrive 15 minutes prior to your scheduled appointment and we will assist you with the paperwork.
  3. Please read the Payment and Fees. Bring your insurance card(s) to the visit. We will need to take a copy of your card(s).
  4. If you take any medications on a regular basis, please bring in the bottles of medications with you. This will enable us to accurately know what you take and help us to proceed with a care plan.
  5. If for any reason you are not able to keep the appointment, please notify our office at least 24 hours before your scheduled time.

If you have any questions regarding any of these materials, do not hesitate to call us at (603) 433-3636. We look forward to meeting you at your upcoming appointment. We are committed to working with you to meet your health care needs.


Lafayette Family Care • 264 Lafayette Road Suite 8 • Portsmouth, NH 03801 •
Phone: (603) 433-3636 • Fax: (603) 433-3939