Decrease (-) Restore Default Increase (+)  font size

For Physicians

At Maine Medical Partners – Neurosurgery & Spine, we are committed to making the intake process an easy and efficient task. This page provides the information and forms necessary to submit evaluation requests

Your Patient Registration Team & the Intake Process

To request a consult for one of your patients, please fax a Medical Evaluation Request form and other requested materials to (207) 885-4402. Telephone inquiries may call (207) 885-4432.

Once we receive the completed form and copies of the most recent clinical notes and diagnostic reports, our physicians will determine the urgency and schedule an appointment. We cannot process intake without all necessary information.

We’ll contact your patient by phone about the appointment, and your office will receive a fax with this information. A thorough informational packet will also be mailed to the patient about the upcoming appointment.

Medical Evaluation Request

It is essential that this form is completed with the most up-to-date patient information, including the patient’s chief complaint, clinical notes related to the problem and prior three months’ notes, current medications and the type of evaluation requested. This form should be faxed to (207) 885-4406, for both neurosurgical and spine center referrals. The more detailed information we receive, the quicker we are able to determine and address the specific needs of the patient.

Medical Evaluation Request

Managing the Patient's Care Plan – Working Together

We know that communication between providers is an essential key to managing a patient’s care plan. Our providers and staff are committed to keeping the lines of communication open and working together to create a cohesive team – informed and involved in the patient’s care plan.