Forms

(Please click on any form or question to view and/or to print.)

Introductory Information for Our Patients

Office Information for New Patients

New Medical Patient Forms

New Adult Intake Forms
New Pediatric (0-18) Intake Forms
Notice of Patient Privacy (HIPAA)  (to view or print)
Patient Consent Release/Financial Policy (included in packet above)
Medical Records Release form  (included in packet above)

New Counseling Patient Forms

New Counseling Patient Packet
Primary Care Provider Release
Adult Screen

Miscellaneous forms or information (to view or print)

Forms for Annual Exam/Physical
Pediatric Annual Visit Forms
Forms for Annual Wellness Visit
HealthInfoNet Opt Out
Flu Vaccine Consent Form
Flu Vaccine Information Statement (CDC)
What is an ABN?
ABN form
What is a PA?
Advanced Directive form
What is Marriage and Family Therapy?
Patient Satisfaction Survey form
Insurance and Payment Policies
Driver Medical Evaluations
Preventative Exam Information
Disability Placard

TEL (207) 563-3366

80 RIVER ROAD
NEWCASTLE, MAINE 04553

FAX (207) 563-3393

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