New Primary Care Patient Appointment Request

To request an appointment and become a new primary care patient at Core Physicians, please complete this online form and a representative will call you within 1 business day. For immediate assistance, please call 603-580-7700 (Monday-Friday: 7am to 5pm)

View PCP’s accepting new patients: Family Practice (family) | Internal Medicine (adults)

If you have symptoms of an urgent nature, please call your doctor’s office or go to the nearest emergency room.

First Name:
Last Name:
Date of Birth:




Personal Phone #:	( ) - Second three digits Last four digits
Email Address:
Preferred Call Back Time:
Reason for Appointment:

Request an Appointment

New Primary care patient appointment request

New Primary Care Patient Appointment Request