Patient Resources

For your convenience we have provided printable versions of the most common insurance claim forms and our most common True North forms. In order to protect your privacy, these forms cannot be altered and returned via email or the internet. You may mail completed forms to us in advance of your appointment as needed.

True North Forms

PDF.gif Records Release Form

PDF.gif True North Adult Medical Questionnaire

PDF.gif True North Medical Symptoms Questionnaire (MSQ)

PDF.gif True North Personal Health History Form

PDF.gif True North Pediatric Health History Form

PDF.gif True North Pediatric Behavioral Health Questionnaire

PDF.gif True North Facility Fee Letter (Nov 2010)

PDF.gif True North Facility Fee Fact Sheet

Insurance Claim Forms

Anthem Claim Form (231kb)

Cigna Claim Form (134kb)

Harvard Pilgrim Claim Form (137kb)

United Healthcare Claim Form (53kb)

Generic Medical Claim Form (361kb)

The Aetna Claim Form is unavailable for downloading, but please call us at 207-781-4488 for a hard copy or visit the Aetna website.

Adobe Acrobat Reader is required to open these forms 


(207) 781-4488

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