Coming in for an appointment? Get the paperwork out of the way before your visit! Below find the paperwork needed by your insurance. You can print and fill this out at home and bring it in on the day of your appointment or you could fax it to our Main Office in Norway at 207-743-5563.
E-mail it to email@example.com
please include your name and paperwork in the subject line
Fax it to (207) 743-5563
Or bring it into your first appointment. Please call us with any question (207) 743-5493.
Are you covered by Medicare or Mainecare? If yes, please fill out the following forms:
Are you covered by a Commercial Insurance or a Workers Compensation Agency/Claim or would like to Pay Privately*? If yes, please fill out the following forms:
Are you working with an Attorney for this injury or have an open claim from a Motor Vehicle Accident? If yes, please fill out the following forms:
If you are not covered by Insurance, we do offer Private Payment rates which are listed below:
$110 Initial Evaluation
$95 Follow up visits