Forms & Insurance
New Patient Forms
New patients can save time during their first visit by completing and submitting the following forms online. Simply click on the form’s title to submit the requested information. Please note that all information submitted via these forms will be kept confidential as befits the nature of the contents.
Click on the button below to download the form. Please complete the form and then upload it to us using the form on this page.
If you have a lengthy medication list, please bring it with you and we will make a copy.
Injury Specific Questionnaires
Click onto the appropriate link for your problem and fill out the questionnaire to the best of your ability. Once completed, fill out your name, copy and paste the following email into “Clinician email to share score with”, and click the share button! office@grayptcenter.com
205 Portland Rd
PO Box 1047, Gray, Maine 04039
Tel: (207) 657-5600
Fax: (855)-464-0106
office@grayptcenter.com
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:
Gray, New Gloucester, Raymond, Cumberland, North Yarmouth, Pownal