Forms

Thank you for taking a few minutes to fill out the forms for your appointment. Completing the forms helps us prepare for your appointment and make it more efficient. Also, if you have an issue that may be more appropriate for another setting, we can let you know before your appointment, and it may save you some time and money.

New patient instructions

  1. Complete the new patient form

  2. Look under issues and complete a form for each issue you would like to address. If you do not see your issue listed, please complete the other issue (form not found) form. If you have more than one issue that is not listed, you can put them all on one "Other issue" form.

  3. If you have medical records you would like me to have, you can fax them to 506-700-6425. If you would like me to request your records from another doctor/hospital/other, I will email you a medical release form that you can fill out and sign with your phone.

Established patient instructions

  1. If any of your personal information (e.g. phone, address, email) has changed since I last saw you, please complete the established patient personal information change form.

  2. If you have had any significant changes in your medical history (e.g. diagnoses, medications, allergies, family history), please complete the established patient medical information change form.

  3. Under issues please complete a form for each issue you would like to address. If you do not see your issue listed, please complete the other issue (form not found) form. If you have more than one issue that is not listed, you can put them all on one "Other issue" form.

Personal information / Medical history

New patient form

Established patient personal information change

Established patient medical information change

Issues

Alcohol use disorder
Allergies
Anxiety
Asthma
Back pain
Birth control
Cough
Crohn's disease
Depression
Diabetes, type 1
Diabetes, type 2
Eczema (atopic dermatitis)
Erectile dysfunction (ED)
Eye redness / discharge
Fever blister / Cold sore
Gout
Herpes, genital
High cholesterol
Hypertension (high blood pressure)
Hypothyroidism (low thyroid)
Insomnia
Menopause (hormone replacement therapy)
Migraine headache
Neck pain
Opioid use disorder
Other issue (form not found)
Overweight / Obesity / Desire to lose weight
Psoriasis
Psoriatic arthritis
Poison ivy / Contact dermatitis
Rash
Sinus congestion / Sinusitis
Sore throat
STD screening / infection (female)
STD screening / infection (male)
Urinary tract infection / UTI (female)