Patient Forms

Please print and fill out both of the forms linked below prior to your new patient appointment!

FAX, TEXT or EMAIL these forms to the office.

Patient Consent HIPPA Signature Form

New Patient Health History Form

Have questions?

Give us a call or text at 207-307-0816

Fax: 207-433-1050

email: FormFunctionOsteopathic @ gmail  

To get to the office:

Follow the sidewalk outside to the side of the building facing Harlow street.  

Do NOT go in the lobby.


Form and Function Osteopathic Medicine

One Cumberland Place, Suite 112

Bangor, Maine

All insurance accepted

Medicare preferred provider