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Request An Appointment

207-582-2222

Filling out forms beforehand saves you time and ensures that you are able to provide all the necessary information to the doctor so that he or she gets the most complete picture of your overall health. It makes your visit to our office more efficient for you.

You may stop by the office during our normal business hours (8am-12pm and 2pm-6pm M-F, 7:30am-11:30am Sat) and pick up the paperwork, or print out the forms and complete them at home.

We ask that you complete the forms as close to your appointment time as possible so that your doctor may have the most current information regarding your condition. Bring your completed forms with you to your appointment along with your driver's license and any insurance cards.

We look forward to seeing you at your visit!


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The following forms need to be completed by:
(Click on the name of the form, in blue, to open the form for printing)

  • New patients
  • Patients returning to our office after a one-year (or longer) absence
  • Existing patients with a new workers' compensation injury or who have been involved in a motor vehicle accident

Registration Form

Notice of Privacy Practices
This form explains our policies and your rights regarding our disclosure of your Protected Health Information. This form must be signed and dated before a file for you can be started in our office.

Consent to Treat a Minor For all patients under the age of 18. This form must be completed by the minor's parent/legal guardian before the child may be seen in our office.

Child Health History Form Complete this form for patients age 0-10

For all patients age 11 and older:

Complaint Form Side 1
Instructions: List each complaint separately and in the order of severity with the complaint that is most severe listed as the chief complaint. For example if you have lower back pain and foot pain these are two separate complaints. The one that is bothering you the most should be listed as the chief complaint. We provide room for two complaints on side 1, if you have more than two complaints, feel free to use multiple copies of side 1.
Complaint Form Side 2

Health History Side 1
Note: You only need to check if you have had a condition in the past or if you have it now, you do not need to check all the "Nos".
Health History Side 2

If you have complaints in any of the following areas, please fill out the corresponding form(s):

Ankle
Carpal tunnel
Headache
Knee
Low back
Neck
Shoulder
Wrist

Additional forms for all patients with a workers' compensation injury: (In order to make this process as smooth as possible for you, contact Vicki in our billing department with all the necessary claim and contact information prior to your first appointment with us.)

Worker's Compensation Patient History
Medical Reports and Doctor's Lien
Permission for Attorney to Share Information

Additional forms for all patients who have been in a motor vehicle accident: (In order to make the process as smooth as possible for you, contact Vicki in our billing department with all the necessary claim and contact information prior to your first appointment with us.)

Personal Injury Patient History
Medical Reports and Doctor's Lien

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