(207) 657-5600 office@grayptcenter.com

Patient Medical History

  • Date Format: MM slash DD slash YYYY
  • Medications and Supplements

  • NameReason (Pain, BP, Diabetes etc )How Much (Mg)How Often (per day or wk)How Taken mouth, inject) 
  • NameReason (Pain, BP, Diabetes etc )How Much (Mg)How Often (per day or wk)How Taken (mouth, inject) 
  • NameReason (Pain, BP, Diabetes etc )How Much (Mg)How Often (per day or wk)How Taken (mouth, inject) 
  • HeightWeight

205 Portland Rd
PO Box 1047, Gray, Maine 04039

Tel: (207) 657-5600
Fax: (855)-464-0106

office@grayptcenter.com

Founding Members of:
Proudly Serving The Following Communities:
Gray, New Gloucester, Raymond, Cumberland, North Yarmouth, Pownal

Our Affiliate:
Premier Physical Therapy
316 Portland Rd

Bridgton, Maine 04009

Tel: (207) 647-2727

205 Portland Rd
PO Box 1047, Gray, Maine 04039

Tel: (207) 657-5600
Fax: (855)-464-0106
office@grayptcenter.com

Our Affiliate:
Premier Physical Therapy
316 Portland Rd

Bridgton, Maine 04009

Tel: (207) 647-2727

Founding Members of:
Proudly Serving The Following Communities:
Gray, New Gloucester, Raymond, Cumberland, North Yarmouth, Pownal