Patient Forms

Release of information 

We are all about collaboration.  We can request records from other providers on your behalf with your permission. In addition, if you would like your records sent to another provider, we can do so with your permission.


FormS can be completed in two ways.

  1. Print out the form and submit via email or bring to your appointment.

  2. Use the online version to complete and submit online


We will do the rest.

Get my information FROM another provider



Send my information TO another provider

Fulcrum Family Health​
Whole family health care, combining modern technology with old-fashioned service
Contact Us
42 Mallett Drive, Suite 3
Freeport, ME 04032
(207) 869-5815
(207) 835-4091 (fax)
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