.png)
Patient Forms & Policies
Download these easy to use forms to print and fill out prior to your visit. We look forward to seeing you. Once complete, you may send forms to us via Secure File Upload, mail, or fax to our Medical Records Department at (207) 523-8581.
New Patient Forms
For all new patients:
Please complete prior to your appointment:
Additional Forms:
Please complete applicable forms prior to your appointment:
Adult (18+ years old)
- Adult Communication Authorization
- New Adult Medical History Form
- New Adult Medicare Health Risk Assessment Form (only needed if you have a Medicare Advantage plan*)
Pediatric (17 years old and younger)
Ob-Gyn
Established Patient Resources
Forms:
- Acknowledgement of Self-Pay Status Patient Responsibility
- Authorization To Disclose Protected Health Information (PHI)
- Authorization To Disclose Protected Health Information (PHI) for Disability or FMLA
- Maine Health Care Advance Directive
- Release of Immunization Records for school, camp, etc. (Pediatric patients)
Informational:
Missed Appointments
When you call to schedule an appointment, our dedicated team makes every effort to accommodate your schedule.
We ask that you notify us 24 hours in advance if you are unable to make an appointment. Missing an appointment or canceling on short notice often prevents us from caring for other patients.
What if I miss an appointment?
-
A patient who misses a scheduled appointment without providing 24-hours’ notice of cancellation is considered a “no-show.”
-
An established patient who is a no-show three or more times within an 18-month period may be dismissed from the practice.
-
A new patient to the practice who no-shows or cancels their initial appointment two times with less than 24 hours’ notice shall have their new patient status retracted and will be discharged from the practice.
We understand that extenuating circumstances affect people from time-to-time and will review each situation individually.
Behavioral Health
Welcome to our Behavioral Health Resources, a curated collection of valuable resources designed to support and enhance your mental and emotional well-being. In navigating life's challenges, accessing the right tools and information is crucial. Whether you are seeking guidance on managing stress, coping with anxiety or improving overall mental health, this resource list offers a diverse range of materials. Your mental health journey matters, and we are here to help you every step of the way.
