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Join us in our efforts to reduce waiting time and to increase time with our patients.

Please download, print and fill in the form(s) that applies to you prior to your appointment:

 

Patient Information Form (PDF)

Patient Contact Information Form (PDF)

Authorization to Treat (PDF)

Caregiver Communication Form (PDF)

Authorization to Release Health Information (PDF)

Authorization to Obtain Prescription History (PDF)

Affordable Care Program Application (PDF)

Generic Drug List, Hannaford (PDF)

Advanced Directive (PDF | Facts )

Bus Driver Form (PDF)

Commercial Driver Medical Examination Form (PDF)

Driver Medical Evaluation, BMV (PDF)

Disability Plates/Placards Applications, BMV (PDF)

Certification of Health Care Provider for Employee’s Serious Health Condition (Family and Medical Leave Act – 1) (PDF)

Certification of Health Care Provider for Family Member’s Serious Health Condition (Family and Medical Leave Act – 2) (PDF)

 

Sports Physical, Student’s Section (PDF)

School Asthma Plan, RSU20 (PDF)

 

If you have any questions concerning one of the above forms, please contact our administrative office at 207.338.6900

Thank you for your support.