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Primary Care

Specialties & Services

Skip to content

Primary Care

Specialties & Services

Patient Forms & Policies

questionnaire-iconDownload 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

Adult (18+ years old) Patient Forms and Information:

Please complete prior to your appointment:

  1. New Adult Patient Authorization Form
  2. Authorization To Disclose Protected Health Information (PHI)-Fillable and Printable (to obtain records from your previous provider)
  3. New Adult Medical History Form
  4. New Adult Medicare Health Risk Assessment Form (only needed if you have a Medicare Advantage plan*)
  5. New Patient Financial Policy, Language Services and Notice of Privacy Practices

Pediatric (17 years old and younger) Patient Forms and Information:

  1. New Pediatric Patient Authorization Documents
  2. New Patient Medical History Form
  3. New Patient Financial Policy, Language Services and Notice of Privacy Practices

Patient Forms

Adult (18+ years old) Patient Forms and Information:

Please complete prior to your appointment:

  1. Adult Patient Authorization Form
  2. Acknowledgement of Self-Pay Status Patient Responsibility
  3. Authorization To Disclose Protected Health Information (PHI)-Fillable and Printable
  4. Authorization To Disclose Protected Health Information (PHI) for Disability or FMLA – Fillable and Printable
  5. Maine Health Care Advance Directive

Pediatric (17 years old and younger) Patient Forms and Information:

  1. Newborn discharge instructions and resources
  2. Teen Resource Packet
  3. Pediatric Patient Authorization & Communication Form
  4. Release of Immunization Records for school, camp, etc. (Pediatric patients)

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.

Behavioral-Health