Southern Maine Integrative Health


New Patient Info & Patient Forms
 
Privacy Policy  
 

Dr. Mulcahy is not accepting:
- New patients who want him to be their Primary Care physician
- HMO insurance plans
- New Medicare or Mainecare plans, including those who are already patients

 

Forms for Dr. Mulcahy's patients:

Receipt of Notice of Privacy Policies & Consent Form

 

Registration Form

 
Adult Intake Form  

Office Policies

 

Financial Policies

 
Child Intake Form  
Patient's Authorization Form  
     

Forms for Gloria Oppen's patients:

Receipt of Notice of Privacy Policies & Consent Form

 

Registration Form

 
Intake Form  

Office Policies

 

Financial Policies

 
     

Forms for Dr. Mosiello's patients:

Receipt of Notice of Privacy Policies & Consent Form

 

Registration Form

 
Adult Intake Form  

Office Policies

 

Financial Policies

 

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.