Questionnaires and Forms

Patient Questionnaire:

To assist a Chest Medicine Associates physician in providing a comprehensive evaluation, at the direction of your health care provider, please complete the New Patient Packet and return to Chest Medicine Associates. Upon receipt of all documentation from your health care provider and your Patient Questionnaire, our consultation coordinator will call you to schedule an appointment. Completed documents can be mailed to Chest Medicine Associates, 100 Foden Road, Suite 103, South Portland, ME 04106 or fax to 207-828-0188.

New Patient Packet

Transfer of Care Documents / Health Care Information Release Form:

CMA (Chest Medicine Associates) Health Care Information Release Authorization Form. - This form is used as a general release agreement. Please contact Chest Medicine with any questions at 207-828-1122

If you are a Western Maine Medicine telemedicine patient, you can download our telemedicine patient packet here: Telemedicine Packet.