Patient Forms & Policies
Patient Forms
Download these easy to use forms to print and fill out prior to your visit. We look forward to seeing you.
Adult Patient Authorization & Communication Form (updated June 2023)
Pediatric Patient Authorization & Communication Form (updated June 2023)
Authorization To Disclose Protected Health Information (PHI)-Fillable and Printable
Authorization To Disclose Protected Health Information (PHI) for Disability or FMLA – Fillable and Printable
Maine Health Care Advance Directive
Release of Immunization Records for school, camp, etc. (Pediatric patients)
Acknowledgement of Self-Pay Status Patient Responsibility
New Patient Forms and Information
Please complete prior to your appointment.
New Pediatric Patient Authorization Documents (updated June 2023)
New Adult Patient Authorization Documents (updated June 2023)
Authorization To Disclose Protected Health Information (PHI)-Fillable and Printable (to obtain records from your previous provider)
New Adult Medical History Form (updated June 2023)
New Adult Medicare Health Risk Assessment Form
New Patient Financial Policy, Language Services and Notice of Privacy Practices (updated June 2023)
Pediatric Patient Forms and Information
Newborn discharge instructions and resources
Teen resource packet
Missed appointments
When you call to schedule an appointment, our dedicated physicians make every effort to accommodate your schedule — often on that same day when you are ill.
Because of the great demand on our medical staff’s time, we ask that you notify us 24 hours in advance if you are unable to make an appointment. Missing an appointment or cancelling on short notice often prevents us from caring for other patients.
If you 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.
