Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Patient Registration

Alternatively, you may download and complete our Patient Registration Forms. After you have completed the forms, please fax them to our Bangor office at Bangor Office Phone Number (207) 945-5691 , or bring them in at your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

• Financial Agreement
• Patient Demographics
• Patient Health History
• Patient HIPAA Form
• Permission for Release of Information
• Notice of Privacy Practices
• Receipt of Notice of Privacy Practices