Thank you for considering Galbraith Family Medicine, LLC, for your care! We are committed to providing quality care to the entire family, with an emphasis on treating the whole person and on promoting healthy living to prevent disease.
In order to serve you best, please take the time before you complete this paperwork to call our office so that we may be sure that we are in your insurance network and that we can meet your health needs.
If we have confirmed that we can meet your needs and have asked you to send us completed new patient paperwork, please print off the forms from this page and mail or hand-carry them to our office at 44 Elm Street, in Limerick. We will forward the signed “Authorization To Release Protected Health Information” form to your current health provider to obtain your health records. Once we have that information in-hand we will be able to schedule you for an appointment. We look forward to meeting you!
New Patients
If you are joining our practice, please download and complete the New Patient Packet. This comprehensive set of forms helps us understand your medical history and establishes the necessary consents for treatment and billing.
Please complete and return these forms at least one week before your first visit. Having your records and history in hand allows us to focus entirely on your health during our first meeting.
- Includes: Registration & Consent, Patient History, Signature on File, and HIPAA Acknowledgment.
What to bring to your first visit:
- Your photo ID and current insurance card.
- Your co-pay (payment is expected at the time of service).
- A list of all current medications, including dosages.
Medical Record Requests
To provide “whole person” care, we need your previous medical records. Please use the form below to authorize the release of your records from your former provider to our office.
Medicare Beneficiaries: Advanced Primary Care Management (APCM)
Medicare has introduced a beneficial program designed to support the ongoing, day-to-day coordination of your care between office visits. This program helps our staff manage specialty referrals, insurance approvals, and medication refills more effectively.
- Key Benefits: Enhanced access to your care team, proactive monitoring of chronic conditions, and 24/7 access to care management.
Privacy Practices
Your privacy is our priority. You may review our Notice of Privacy Practices below, which describes how your medical information may be used and disclosed.
Important Notes:
- Cancellations: If you are unable to keep your appointment, please notify us at least 24 hours in advance so we may reschedule you.
- Insurance: We recommend calling your insurance provider before your first visit to confirm that we are in your network.
- Self-Pay: For patients without insurance, we offer a 40% discount if the balance is paid in full at the end of the visit.
Questions? Please call our office at (207) 793-9586.
Monday through Friday from
8am to 12pm & 1pm to 5pm
Galbraith Family Medicine, LLC, participates with most major insurance carriers with the exception of MaineCare. Please check with your insurance company to be sure we are in-network before choosing us. Please note that we cannot care for Medicare patients who have MaineCare as their secondary insurance.
Although we make every effort to have a general working knowledge of individual insurance policies, the large number of them makes it impossible for us to keep track of the specifics. Therefore, it is your responsibility to have knowledge of the details of your insurance policy and its requirements. The insurance company can assist you with this; remember to document with whom you spoke and when, as well as the details of your conversation.