Name *
Date of Birth *
Date of Birth
Address *
Best contact phone number *
Best contact phone number
Is it okay to contact you at this number? *
Is it okay to contact you at this email address? *
We want to take every step to protect your privacy so please let us know if it is okay to contact you via email
May we add you to our mailing list *
Periodically, we would like to notify you of new services, important health information items and tell you how much we appreciate your business
If you are requesting a medication refill, please include the name of the medication, dose, how often you take the medication and whether or not you would like a 30-day or 90-day supply. Feel free to put as many medication refill requests as you need in the box.

Office hours:
Monday 8:00-12:00
Tuesday 7:00-4:00
Wednesday 7:00-4:00
Thursday 7:00-4:00
Friday 8:00-12:00

603 Main Road North
Hampden, ME 04444
office: 207-945-5400
fax: 866-463-6751
twitter: @ocfm