Southern Maine Integrative Health


New Patient info & Patient Forms
 

Receipt of Notice of Privacy Policies & Consent Form

 

Registration Form

 
Adult Intake Form  

Office Policies

 

Financial Policies

 
Waiver  
Child Intake Form  
Individual Patient's Authorization Form  
Privacy Policy  

Due to the new Red Flag regulations, we are required to implement a plan in our office that will protect our patients from medical identity theft. All patients will have a copy of their photo ID placed in their file with a copy of their insurance card that has their name printed on it. Please bring these cards to your first visit, along with your completed Registration, Intake, and Receipt of Privacy Policy forms.