Policies and Forms


Thank you for choosing Kittery Family Practice for your medical needs!  The following information may be helpful to you.  We accept all types of insurance and payment forms.   Please call our office at 207-439-4430 to book your new patient appointment.

Prior to your FIRST  appointment at Kittery Family Practice:

We would like to review your medical history in advance, so please forward your past medical records from you previous provider to our office prior to your first appointment.  
  • Review the York Hospital Privacy Practices document on this website. 
  • Then complete the patient information form (Adult or Pediatric), confidential medical information form, and patient acknowledgement of receipt of privacy practices prior to the first appointment. 
These forms may be downloaded from this website and printed so that you may complete them at home.  If you are unable to print and complete the forms prior to your appointment, we will supply the forms at your first appointment.  Please arrive 15 minutes prior to your first appointment so that you may have time to complete the required paperwork.   Contact your insurance company to notify them of your new primary care provider.

New patients are asked to bring to their initial appointment:

  • Prescription medicine bottles and a list of medications, vitamins and supplements.
  • Insurance card, pharmacy insurance card and required co-pay.
  • Completed intake forms. (if completed at home)
  • If intake forms are not completed prior to visit, please arrive 15 minutes early.

MAKING APPOINTMENTS

All visits at our office are by appointment.  We ask that you call well in advance for routine visits, since this allows you the greatest choice of appointment times.  We will try to accommodate your appointment needs to the best of our ability.  The suggested timeframe for making appointments is:
  • Physicals – 1-2 months in advance
  • Follow ups – 1-2 weeks

URGENT APPOINTMENTS

If you experience a life-threatening emergency, please call 911 or go immediately to the nearest hospital emergency department.    If your medical condition is not life-threatening, please call our office during office hours and speak with our triage nurse. The triage nurse will advise a plan of care for your medical condition.  Please note, Myhealth@Kittery Walk-in Care is also available to treat your immediate needs and they are located right at York Hospital in Kittery.  Click here for more information.   For urgent concerns in the evenings or on weekends please call 207-439-4430 and leave a message with our on-call medical answering service. A physician will respond to your call promptly.  Routine medication refills and controlled substance renewals cannot be refilled by on call providers.

CANCELING APPOINTMENTS                                    

If you must cancel your appointment we ask that you do so at least 24 hours in advance.  This will give another patient an opportunity to see a provider.   After hours, please leave a message with our answering service.   Please see the attached no-show/missed appointment policy.    

MISSED APPOINTMENTS                                        

We make reminder phone calls to all scheduled patients two days in advance of their appointment.  If you are unable to make your scheduled appointment, please notify us 24 hours in advance.  If you do not arrive for your scheduled appointment, it will be considered a missed appointment.   Kittery Family Practice has the right to discharge you from this medical practice due to a series of missed appointments.   Please see the attached missed/no show appointment policy.

PAYMENTS AND INSURANCE                                    

We participate with most major insurance carriers.  Payment of co-payments and self-pay patient payments are expected at the time of service.  We accept cash, check, and credit cards.  If you have questions about your statement or if you need to make payment arrangements, please speak with the billing staff.  All billing questions should be directed to a Kittery Family Practice billing representative by calling 207-361-3661.  Self pay patients will be charged a discounted fee.  Please discuss fees with the Kittery Family Practice front office staff.

PRESCRIPTIONS                                            

Kittery Family Practice participates in SureScripts electronic prescribing.  Most prescriptions will be electronically submitted to your pharmacy or your mail order company.  Please be sure to notify our office of your desired pharmacy so that we may place that information in our database.  If you need a prescription renewal, please be sure to request refills during your office visit, or call your pharmacist to determine the status of the refills remaining on your medication. If you do not have another refill remaining, please be sure to call our office well in advance of running out of your medication. This gives us ample time to review your medical record to determine if a prescription is warranted. In some cases, we may ask that you schedule an examination prior to ordering a refill or an additional medication.  We generally do not renew or prescribe medications after hours or on weekends,, so please call during business hours. Most pharmacies will provide you with enough medication at night or over the weekend to ensure you do not run out of medication.

Also, did you know that York Hospital has two retail pharmacies to fill your prescription needs?  York Hospital's Apthecary and Berwick Pharmacy offer personalized service and home delivery!

TELEPHONE CALLS                                            

All patients are encouraged to call with any questions about their medical problems.  When calling during office hours about a prescription or medical question, you may be directed to the provider’s clinical staff voicemail.  All phone messages are checked after lunch and at the end of the day.  All information obtained in the voicemail will be reviewed with the provider and a return call will be made by the end of the day, unless that provider is unavailable.

REFERRALS                                                

Many insurance carriers require the primary care provider to complete a referral for specialty services or diagnostic testing.  Kittery Family Practice requires three days to process the insurance approval and scheduling.  You will be notified during the referral process of its progress and scheduled appointment.  Please check with your insurance carrier to determine policies related to referrals.

MEDICAL RECORDS AND PATIENT CONFIDENTIALITY          

Please read the York Hospital Privacy Policy closely. We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services you receive at Kittery Family Practice and York Hospital to provide you with quality care and to comply with certain legal requirements.  This applies to all of the records of your care generated by Kittery Family Practice, York Hospital and referred physician practices.  

If you wish to release medical information to outside sources (attorneys, life insurance companies, social security, schools, housing agencies etc.), you must request the release in writing (see form attached).
Since your medical record is a legal document, Kittery Family Practice will not release any information without your written consent.

On your first visit to our office, you will be asked which individuals (husband, wife, daughter etc)   have your permission to receive information from your medical record. Please let us know if you desire to make any changes regarding who has your permission to access your medical record.

INCLEMENT WEATHER                                        

As a provider of health care services, we make every attempt to provide services to our patients in inclement or severe weather. However, conditions may arise which pose a serious threat to the well-being of our patients and employees whereby it is in the best interest of all involved to open the office late, close early, or close the office entirely.  During inclement weather, please contact our offices for further information. In extreme conditions, a closure announcement will be made on WOKQ FM (98.5) and Z107 FM (107.1).
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