Covid-19 Update: Our medical providers make your health our number one priority. To minimize the spread of COVID-19, we ask that all visitors wear a mask or face covering while in our facility. Please click here for more information about how we are helping to prevent the spread of COVID-19 and other infectious diseases.

Patient Forms

Here you will find forms that you can fill out, print, and bring to the PHC. Click on each link below and a separate window will appear.

Patient Registration Form 

This form is for the patient’s initial registration.

Patient Release of Information Form 

This form must be used to authorize disclosure of protected health information.

Patient Complaint Form 

This form can be used to submit any comments or concerns that you may have about the PHC

Passamaquoddy Health System Programs