Accepting New Patients

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Patient Portal

Patient Forms


New patients at Greater Portland Health (GPH) are required to complete the following forms in order to become a patient. Please have personal information such as name, date of birth, social security number, as well as health insurance information, household income, and emergency contact ready before completing the registration. 

New Patient Registration Forms

New Patient Forms - English

New Patient Forms - French

New Patient Forms - Portuguese

New Patient Forms - Spanish

New Patient Forms - Arabic

Please bring completed New Patient Registration Forms with you to your first appointment. 

Consent to Treatment Form

Consent to Treatment - English

Release of Information (ROI)

ROI - English

 

Fully completed and signed ROI forms may be faxed to the Medical Records Department at 207-874-0101 attn. Keri W. 

Please note that all applicable fields must be completed for this ROI form to be considered valid, accepted, and processed.

Per Maine Law GPH Medical Records Department has 30 days to process the ROI request.

The charge for a paper copy of medical records is $5.00 for the first page and 45¢ for each additional page (up to a maximum of $250 for the entire medical record/report). The charge for electronic copy of medical records via CD is a flat fee of $5.00.