Intake Forms Directions

Please complete, sign, and submit an age-appropriate intake form (see below).  Dr. Grace will review your completed form.

Instructions for completing the form:
1.  Download the appropriate form.
2.  Save the form to your desktop, then open the form from your desktop with Adobe Reader.  Mac users should use Preview or Adobe Acrobat. 
3.  Fill in your name, save and close the form, then reopen the form from your desktop. Make sure your name saved to the form.  (You could lose all your data if the form doesn't save properly!)
4.  Complete the form. 
4.  Save your completed form and send it to us as an attachment through the secure web form at the bottom of this page.
6.  If you have any trouble, please call us at 207-338-1130. 

(Alternatively, you can also print out a blank form, fill it out by hand, and mail it to us.)

To send your forms please use our Secure Encrypted Web Form!

Name*:

Email address*:

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Attach a File/s:

* Required fields. Remember to SAVE your completed form before sending!