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  • About Us
    • David Meyer, Ph.D.
    • Jonathan M. Borkum, Ph.D.
    • Stacy Whitcomb-Smith, Ph.D.
    • Chantal N. Mihm, Psy.D.
    • Christina Fasse, Psy.D.
    • Melanie Miller, LCPC
    • Mark Kmen, LCSW
    • Laura A. Foster, Ph.D.
    • Rachel E. Goetze, Ph.D.
    • Jeff Matranga, Ph.D., ABPP
    • Directions
  • Treatments and Disorders
    • Pain Management
    • Headaches
    • Biofeedback
    • Anxiety Disorders
    • Panic Disorder
    • Worry - Generalized Anxiety Disorder
    • PTSD & Acute Stress Disorder
    • Obsessive-Compulsive Disorder (OCD)
    • Social Anxiety Disorder
    • Medications or Not?
    • Coping with Cancer
    • Grief Services
  • HIPAA
    • HIPAA Privacy Notice
    • HIPAA Outpatient Therapy Agreement
  • Online Forms
  • Meditation Resources
You are here: Online Forms

Health Psych Maine Online Forms

Forms for All New Clients to Complete

Consent for Services

Notice of Privacy Practices

Electronic Communication Policy

Attendance and Cancellation Policy

Release Form

Credit Card Authorization Form

Pre-Appointment Questionnaires

You must login before accessing these Pre-Appointment Questionnaires. 
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  • Questionnaire for Counseling
  • Headache Questionnaire
  • Pain Questionnaire
  • Coping with Cancer Questionnaire
  • PCL-5 Form
  • Returning Client Questionnaire
  • Headache Retest Questionnaire
  • Pain Retest Questionnaire
  • Counseling Retest Questionnaire
  • Beck Depression Inventory
 
  • Bariatric Presurgery Questionnaire
 

Additional Forms

  • Informed Consent
  • OCI-R

Information

  • Directions

Waterville Location
2 Big Sky Lane
Waterville, ME 04901

 

Bangor Location
(Only for pain management and headache, provided by Dr. Borkum.)
Northeast Pain Management
1365 Broadway
Bangor, ME 04401

 

Phone: 207-872-5800
Fax: 207-872-5888

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