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  Cosmetic  Medicine


Harry H. Payton, D.O.
Christopher B. Murry, D.O.
John H. Roediger, M.D.

Registration

 

Whether you are currently an established patient, or a new patient to our practice, please complete the following forms.

*Please note if you are already an established patient, but have not been seen in two years you must send updated forms.

All forms must be mailed to our main office
HEAD AND NECK SURGICAL ASSOCIATES
1250 Forest Avenue
Portland, Maine 04103
Forms will require 3 pages to be printed
Forms will print as an 8 by 10

Before mailing forms, please call our office to make an appointment at that time please let the receptionist know that you have obtained forms from our website. Please also note that you need Adobe Acrobat Reader to view the registration and history forms.

207-797-5753 or 1-800-300-1250

Registration Form
Consent Form
History Form



Ear, Nose & Throat · Head & Neck Surgery · Facial Plastic Surgery
Audiology · Hearing Aid Services · Infant Hearing Screening
Telephone: (207) 797-5753 · Fax (207) 797-9571