Patient Information & Forms
Adult Medical Health History Form
This form will help your clinician better understand your medical concerns and conditions.
Pediatric Medical Health History Form
This form will help your clinician better understand you or your child’s medical concerns and conditions.
Authorization to Release Health Information - EASTPORT Medical & Behavioral
Authorization to Release Health Information - MACHIAS Medical & Behavioral
Authorization to Release Health Information - DENTAL
Appointments are preferred. Please call during regular hours. Every effort is made to see you at the time of your appointment, but patients with special or urgent problems must take precedence. Walk-in patients will be seen when free time allows, or after those with appointments have been seen.
All patients must report to the receptionist upon arrival for each visit to assure you will be seen as scheduled. Please bring your insurance card with you at each visit.
If you cannot keep your appointment, please notify us as far in advance as possible and reschedule your appointment for another time. This courtesy will enable us to give your appointment to another patient who needs to be seen.
Your First Visit
If this is your first visit to Eastport Health Care, plan to arrive early to allow time to fill in the patient questionnaire. This will provide important information for your health record and will be of great value to the provider. To save time, download and print the Patient Registration Form on this page and bring the completed form with you.
If you need to have a prescription refilled, you are urged to call the Health Center early in the morning. Please call in your prescription one week prior to running out. This courtesy will allow the providers enough time to place your order.
Eastport Health Care is a non-profit organization and in order to keep providing high quality services, a reasonable fee must be charged. We make every effort to keep down the cost of your health care. You can help by paying at the time of your visit.
If you are having difficulty with your bill, please discuss this with us privately; we will be happy to answer questions regarding payment for services or our fees. The Health Center has available a sliding fee scale, based upon family income. Details will be provided on request when you pay your bill. MasterCard and Visa are also accepted.
Physician Return Telephone Calls
So that the providers can give full attention to their patients, the receptionist takes all incoming calls. The provider will return your call at the earliest opportunity. Emergency calls will be dealt with immediately.
Eastport Health Care is a participant of HealthInfoNet's Health Information Exchange, a secure electronic system where health care providers can share important patient information, giving them the tools they need to make more informed treatment decisions, especially in an emergency.
Eastport Health Care is a non-profit organization and thus your donations may be deducted from your tax return. Donations are greatly appreciated.