Patient Forms & Policies
Find forms, resources, and policies all in one place!
Medical Form Requests
Need InterMed to complete a medical form?
InterMed partners with Verisma to provide a more convenient and consistent process for medical form completion. Through Verisma, you can submit your form online, receive status updates by text or email, and securely access your completed form when it is ready.
Have a question for Verisma? Call 207-430-9560.
How it works
- Submit your form online.
Upload a blank copy of your form and photo ID, then provide the requested information. - Select your preferred turnaround time.
Standard processing is available within up to seven business days. Expedited processing is available within three business days for an additional $20. - Receive updates directly from Verisma.
Once your request has been submitted, Verisma will be your primary contact for questions about the status of your request, payment, missing information, or delivery.
Some forms may have a processing fee. Any applicable cost will be provided before your request is processed.
Eligible Forms
Verisma can assist with many types of forms, including:
- FMLA and disability forms
- Workplace accommodation forms
- Workers' compensation forms
- Physical and health assessment forms
- Transportation forms
- Updates or continuations of previously completed forms
- Other forms requiring information from a patient's medical record
If your form cannot be submitted through Verisma, please upload it using InterMed's Secure File Upload.
Have questions about submitting a medical form through Verisma?
Find answers to common questions about the process, timing, fees, and what to expect after you submit your request.
Why is InterMed using Verisma?
InterMed partners with Verisma to provide a more consistent and convenient process for medical form completion. Patients can submit forms online, receive updates directly, and securely access completed forms, while allowing InterMed’s clinical teams to spend more time focused on patient care.
Is Verisma part of InterMed?
Verisma is an outside company that partners with InterMed to securely manage medical form requests.
Is the process secure?
Yes. The online process includes identity verification and a HIPAA authorization. Forms and medical information are handled through Verisma's secure system.
Do I still bring the form to my clinician?
No. Please submit the blank form through the SUBMIT A MEDICAL FORM button on this page.
Will my clinician still be involved?
Verisma completes the form using information documented in your InterMed medical record. If clinical input is needed, Verisma will coordinate with your care team.
Do I need an appointment?
You do not need an additional appointment solely to submit a form. However, your clinician may need to evaluate you or order testing if the information required for the form is not already documented in your medical record.
What can I do to prevent delays?
Submit a complete, blank copy of the form and provide all requested information. You should also complete any required appointments, lab work, imaging or other testing as early as possible.
How will I receive updates?
Verisma will communicate with you directly by text or email. It will let you know if information is missing and provide instructions for securely accessing the completed form.
Have a question for Verisma? Call 207-430-9560.
Can Verisma send the form to my employer, school, or another organization?
Yes. You can provide the recipient and delivery information when submitting your request.
Is this the same as requesting my medical records?
No. Form completion and medical-record requests are separate services, although InterMed partners with Verisma for both.
What if Verisma does not offer my form?
There are a select number of forms that Verisma does not take – including return-to-work, fitness-for-duty, school, camp and sports forms. Please upload these forms using InterMed's Secure File Upload.
Patient Forms & Resources
Looking for a form to complete before your visit? Access e-sign and printable InterMed forms below.
E-signed forms require no additional interaction once submitted. If you choose to provide your email address during this process, you will receive a notification shortly afterward that the form has been deleted. That is confirmation that your form has been moved into your patient chart and removed from the e-sign system.
New Patient Forms
New Patient Forms
New Patient Forms - Adults (18+)
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Adult Patient Information Form (E-Sign)
-
Adult Communication Authorization (E-Sign)
- Adult Medicare Health Risk Assessment Form (only needed if you have any Medicare plan*) (E-Sign)
New Patient Forms - Pediatric Patients (17 and younger)
New Patient Forms - Ob-Gyn
Other Patient Forms
Billing & Financial
Advance Care Planning
Patient Resources
If you would like to release your Medical Records, visit www.intermed.com/medical-records.
Policies
Missed Appointments
We know plans can change. If you need to cancel or reschedule an appointment, please let us know at least 24 hours in advance whenever possible. Giving us advance notice allows us to offer that appointment time to another patient who may need care.
What is considered a no-show?
An appointment is considered a no-show when a patient misses a scheduled appointment or cancels with less than 24 hours’ notice.
What happens if I miss an appointment?
- Established patients: Three or more no-shows within an 18-month period may result in dismissal from the practice.
- New patients: If you miss or cancel your initial appointment with less than 24 hours’ notice two times, we may no longer be able to accept you as a new patient.
We understand that unexpected circumstances happen. Individual situations will be reviewed as appropriate.
Additional Policies
Behavioral Health Forms
