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MMC Family Medicine Center 
~ Forms & Information ~

Are you interested in becoming a New PatientPlease call 207-874-2466 to talk to one of our Intake Specialist then Click here for a Registration Form.

New Integrative Medicine patient? Please go to the Integrative Medicine page of this website for a form to bring to your first visit.Be sure you have a referral from your Primary physician prior to setting up your first appointment.

To help decrease down time during your visit, feel free to download, print, and out fill any of the appropriate forms that pertains to you and bring to your appointment, or Print out any form and Fax to ...
Portland at (207) 774-4625
Falmouth at (207) 781-1507

** Release of Records / Communication Release - all (.pdf)
** Release of Records / Incoming Records (.pdf)
** Release of Records / Outgoing Records (.pdf)



** HIPPA (Health Information Privacy Protection Act) Website
** HIPPA  Handout - MMC Policy 
(.pdf)

** MyChart Information (Website)


Important Information about 'Preventive Care or Annual Physicals'

** Generic Drug Lists(.pdf):    MMC,    Hannaford,    WalMart

** Diabetes Self-Care Action Plan (.pdf)
** Asthma Action Plans(.pdf):      for School/Kids      for Adults
** DMV form for Disability Plates/Placecards (.pdf)

** Recommended vaccine list (CDC Website, choose appropriate age group)

** Maine Advanced Directive form(.pdf)   /   Fact sheet from Maine.gov. Website

 ** My Self Care Plan Take charge of your Health; print & send to your physician (.pdf)

Print and fill out the Healthy Habits Survey
Bring with you on your next appointment or fax/mail to us ... 
(.pdf)
Healthy Habits Survey  in English ---->   Ages 2 to 9       Ages 10-18
Healthy Habits Surveys in Somali: ---->   Ages 2 to 8       Ages 9-18
Healthy Habits Surveys in Spanish: ---->   Ages 2 to 8       Ages 9-18 

*** Please use 'MyChart' to email your doctor/team for refills/questions/etc.  If you want more info on MyChart and want to sign up, please call our office ... 207-874-2466


CURRENTLY, FAMILY MEDICINE CENTER
OFFERS THEIR  PATIENTS:
* Behavioral Health (consults & counseling)

* Colposcopy
* Dental Services

* Geriatrics
* Obstetric/GYN
* Dermatology
* Group Visits
* Integrative Medicine

* Podiatry
* Qualifying Medication Program

* Sports Medicine
* Vasectomy
 

 

 

 

 

 

Health Information

Learn about the classes offered at the Learning Resource Center

 

272 Congress Street | Portland, Maine | 04101 | (207) 874-2466
5 Bucknam Road | Falmouth, Maine | 04105 | (207) 781-1500
Toll free: 1-800-265-7703