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(207) 338-6900

Download Forms

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:

Advanced Directive
maine-advance-directive.pdf
71.8 KiB
Affordable Care Program Application
Affordable-Care-Program-Application-2017-05-03.pdf
1.0 MiB
Authorization to Obtain Prescription History
RxHistoryConsent-2016-08-16.pdf
198.9 KiB
Authorization to Release Health Information
Release-of-Information-Combined-2017-06-14.pdf
247.2 KiB
Authorization to Treat
Authorization-to-Treat-2014.pdf
103.7 KiB
Bus Driver Examination Form
Bus-Driver-Examination-Form.pdf
120.0 KiB
Caregiver Communication Form
Caregiver-Communication-2016-09-21.pdf
379.0 KiB
Commercial Driver Medical Examination Form
Commercial-Driver-Medical-Exam.pdf
414.3 KiB
Disability Plates/Placards Applications, BMV
Disability_Placard_Plates_form.pdf
113.3 KiB
Driver Medical Evaluation, BMV
Driver_Medical_Evaluation_Form.pdf
94.2 KiB
Generic Drug List, Hannaford
Generic-drug_list_hannaford.pdf
346.8 KiB
Patient Contact Information Form
Patient-Contact-Information_SeaportCHC.pdf
277.1 KiB
Patient Information Form
Patient-Information-Form-2016-10-28.pdf
724.2 KiB
School Asthma Plan, RSU20
School-Asthma-Plan.pdf
47.7 KiB

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.