558 Main St, South Portland, ME 04106 | mwilliamsdc@maine.rr.com
New Patient Forms
NEW PATIENT FORMS IN PORTLAND, ME
Please click on the following link to fill out the new patient registration form. The information you enter will be directly imported into our software:
Click on this link to go to a registration page.
The following forms also need to be downloaded and printed so you can bring them to your appointment. If you are unable to print these please arrive about 20 minutes early for your appointment to complete them in the office.
Please do not send your personal information by e-mail.
If the patient is under age 18, a parent or legal guardian must sign the forms and must accompany the patient to the first appointment. If the patient is under age 16, a parent or guardian must also accompany the patient to every appointment.
If you have had any x-rays, lab tests, or other treatment related to this condition or to prior episodes of a similar condition, it would be most helpful to the assessment of your health care needs to either have those records sent to the office prior to your appointment or at least for you to bring them with you. If you are not able to get these prior to the appointment we will go ahead with the evaluation and determine at that time how to proceed.
Records from other doctors or facilities may be faxed to (207) 775-3743 or sent via EHR certified encryption to our e-mail address mwilliamsdc@maine.rr.com
Notice of Privacy Policies
Chiropractic Health Alternatives complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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