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Let Us Know What You Think - KVHC CARES Survey

My Patient Portal
RX REFILLS
Patient FAQ

Become A Patient

Thank you for choosing Katahdin Valley Health Center as your healthcare provider!

Follow the easy step-by-step process below to become a new patient here at Katahdin Valley Health Center.

If you have any questions, please call us at 1-866-366-5842 and our team will be happy to assist you. If you have any problems with the form links or would prefer to fill out our forms by hand, please give us a call and we will help you receive a paper or PDF copy.

If this is an emergency, please call 911. If you have an acute need to be seen today, please call us at 1-866-366-5842 and do not use the forms below. Thank you! 

Before your first visit, you will need to complete the form below. Please fill out this form before moving on to the steps below! 

New Patient Request Form 

One simple form will allow you to register for any or all of our services. Please make sure you fill out as much of the form as possible, and don’t forget to check the box letting us know what services you are signing up for!

KVHC New Patient Registration

This form allows us to retrieve your medical/dental records from your previous provider(s). Having these records ensures that we are providing you with the quality care that you deserve!

Health Records Release Form

Please fill out either the application form for our Sliding Fee Discount Program, or the Refusal Form if you feel you will not be eligible for the Sliding Fee or do not wish to take advantage of the discount.

Sliding Fee Discount Application
   
OR
   
Sliding Fee Discount Refusal Form

Please upload your financial documents to support your application here:
Sliding Fee Document Upload Form

With this form, you can quickly and easily transfer your existing prescriptions to our KVHC Pharmacy, located in Houlton, Patten, Millinocket, and Dover-Foxcroft. Our Pharmacy has so much to offer, from the Prescription Savings Plan to Mail Order and Home Delivery!

KVHC Pharmacy Prescription Transfer Form (OPTIONAL)

Please be sure to arrive at least 15-30 minutes early for your first appointment to check in and fill out any remaining forms.

Please Plan To Bring The Following:
  • If you requested paper or PDF copies of our forms, please bring a completed, printed copy of those forms.
  • A valid drivers license or other ID.
  • ALL of your insurance cards, including any Medicare or Medicaid cards.
  • If you have insurance, please bring any copay amount due.
  • Your prescription medication bottles, as well as a list of any over-the-counter medications you take.
  • A list of your health concerns and questions.

Have you changed your Primary Care Provider (PCP) with your insurance?
If you have MaineCare, please call (800) 977-6740 and change your current PCP to Katahdin Valley Health Center.
If you have commercial insurance, please call the number on the back of your insurance card and change your current PCP to Katahdin Valley Health Center.

If you are unable to make your appointment, please contact us at 1-866-366-5842 ext. 332 and we would be happy to reschedule.

We look forward to seeing you!
New Patient Documents
All documents below are in PDF format. Click to view, download, and print.
Creating Healthy Communities, Starting with You.
If you have an emergency and we are closed, please call 911.
You may also call 207-538-3700 to reach our ON-CALL provider for your medical or dental needs.

For out of state calls, you may use our toll-free number: 1-866-366-5842.

KVHC offers translation services via Language Line Solutions. Please see the front desk for details.
KVHC ofrece servicios de traducción a través de Language Line Solutions. Por favor, consulte la recepción para más detalles.
KVHC offre des services de traduction via Language Line Solutions. Consultez la réception pour plus de détails.
For TTY services, please dial 711 to be connected to an operator.

This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. This entity receives HRSA Health Center Program grant funding under 42 U.S.C. §  254b and has been deemed a Public Health Service employee for purpose of certain liability protections, including Federal Tort Claims Act coverage, under 42 U.S.C. §  233(g)-(n).


Katahdin Valley Health Center is an equal opportunity provider and employer.
Katahdin Valley Health Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, national origin or ancestry, age, physical or mental disability, genetic information or predisposition, gender identity, sexual orientation, marital status, parental status, pregnancy, religion or faith, political beliefs, citizenship, veteran status, protected activity under the Maine Whistleblowers Protection Act, filing a prior claim under the Workers Compensation Act, and sexual orientation.

If you wish to file a Civil Rights complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866)632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

Links marked with this symbol:
are provided via our medical records and Patient Portal partner, athenaHealth.
PATIENT PORTAL
KVHC BILLING
PATIENT FAQ
PATIENT RIGHTS
NOTICE OF PRIVACY PRACTICES
BECOME A PATIENT
CAREERS AT KVHC
© 2024 Katahdin Valley Health Center – All Rights Reserved

Sliding Fee Document Upload Form

Use this form to upload the necessary financial documents to support your Sliding Fee Discount Program Application. Be sure to enter your name and date of birth accurately so that we can match your documents to your application. Thank you!
Please enable JavaScript in your browser to complete this form.
Your Name
Click or drag files to this area to upload. You can upload up to 5 files.
Please note: only .pdf, .jpg, and .png file types are supported.

KVHC Pharmacy Prescription Transfer Form

Would you like to receive your current medications at KVHC Pharmacy? Please fill out the form below to the best of your ability to help us transfer your prescriptions to our pharmacy. 

Please enable JavaScript in your browser to complete this form.
Please select a KVHC Pharmacy location where you would like to have your prescriptions filled.
Customer Name
Contact Name (if different from above)
Current Pharmacy Address

Become A Patient Today

Use the form below to begin your journey towards becoming a KVHC patient. Fill out the fields below to the best of your knowledge, and hit the Submit button. A KVHC representative will review your information and get back to you as soon as possible.

Please enable JavaScript in your browser to complete this form.
Name
Date of Birth
Address
I would like to become a patient for the following services: (Please check all that apply.)

KVHC CARES Feedback Form

Let us know what you think! Please tell us about your recent visit to KVHC. 

Please do not ask health care questions on this form. If you have an emergency, please call 911. 

Please enable JavaScript in your browser to complete this form.
I am satisfied with my care at KVHC:
If you would like to be contacted by a KVHC representative about your experience today, please leave your name and e-mail address below.

Question of the Month November 2024

Please answer the question(s) below. You may then enter your contact information for a chance to WIN a $25 food gift certificate!
(All participants must be 18 years or older, and must reside in Aroostook, Penobscot, or Piscataquis County to be eligible for the gift certificate drawing.)
Please enable JavaScript in your browser to complete this form.
Have you cancelled an appointment with KVHC in the last six months?
Please enter your contact information below to be entered into our giveaway.

KVHC CARES Feedback Form

This form is for feedback only, please do not ask medical questions.
If you have a medical emergency, please call 911.
Please enable JavaScript in your browser to complete this form.
I am satisfied with my care at KVHC:
If you would like to be contacted by a KVHC representative about your experience today, please leave your name and e-mail address below.