Patient Forms & Information

Download these easy to use forms to print and fill out prior to your visit. We look forward to seeing you.

New Patient Packets (for Internal and Family Medicine)
Portland - Marginal Way Internal Medicine new patient packet - click to download
South Portland - Foden Road Family Medicine new patient packet - click to download
Yarmouth - Internal Medicine and Family Medicine new patient packet - click to download

Patient Communication Form - click to download
Use this form to tell us how you want us to communicate with you, family members, and outside physicians. 

Authorization To Release Health Care Information - click to download
Use this form to authorize InterMed to release medical records to outside providers, to yourself or to request records be sent to InterMed.

Financial Hardship Application - click to download 

Notice of Privacy Practices - click to download 

Notice of Privacy Practices Acknowledgement - click to download 


Flu Homecare Guidelines - click to download 


Mohs Surgery Information Sheet - click to download

Skin Excision Information Sheet - click to download


InterMed's List of Most Commonly Billed Conditions with Prices - click to download 

Prices for the most frequently provided services. These prices are listed by Current Procedural Technology (CPT) code. You may also call the InterMed Billing Office, (207) 828-0361.
The Maine Health Data Organization has price transparency tools available on its publically available website at www.comparemaine.org.
If you have any questions about the law governing public disclosure of health care prices, (22 MRSA §1718-B), please call the Compliance Officer at (207) 347-2937.

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