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Medical History Form
Dempsey Center Medical History Form Date(Required) MM slash DD slash YYYY Name:(Required) First Last Date of Birth:(Required) MM slash DD slash YYYY Email Primary Care Provider/Oncologist:(Required) Cancer Status Cancer Impact(Required)...Informed Consent – Support Services
Informed Consent for Dempsey Center Cancer Support Services Date(Required) MM slash DD slash YYYY Welcome to the Dempsey Center for Quality Cancer Care. Our mission is to provide quality of...Consent to Telehealth Services
Client Consent to Telehealth Services and Acknowledgement of Receipt of Telehealth Information – Nutrition The Dempsey Center for Quality Cancer Care is committed to improving the health and wellbeing of...Informed Consent – Healing Tree
Informed Consent Agreement – Healing Tree Services Welcome to the Dempsey Centers for Quality Cancer Care, our mission is to provide quality of life services to individuals and families impacted...Informed Consent – Acupuncture
Informed Consent Agreement- Acupuncture Services Welcome to the Dempsey Centers for Quality Cancer Care. Our mission is to provide quality of life services to individuals and families impacted by cancer,...Informed Consent – Oncology Counseling
Informed Consent Agreement-Adult Oncology Counseling Services Welcome to the Dempsey Centers for Quality Cancer Care. Our mission is to provide quality of life services to individuals and families impacted by...Informed Consent – Massage
Informed Consent Agreement – Massage Therapy Services Welcome to the Dempsey Centers for Quality Cancer Care. Our mission is to provide quality of life services to individuals and families impacted...Telehealth Consent – Counseling
Telehealth Services Consent and Acknowledgement of Receipt of Telehealth Information – Counseling Name(Required) First Last Phone(Required) Email The Dempsey Center for Quality Cancer Care is committed to improving the health...Dempsey Center + Beth C. Wright Collaborative Programs
Beth C. Wright Cancer Resource Center Collaborative Programming To help even more people access no-cost support services throughout the state of Maine, the Dempsey Center has teamed up with the...Diversity, Equity, Inclusion, and Access Statement
Diversity, Equity, Inclusion, and Access at the Dempsey Center Our Commitment to Diversity, Equity, Inclusion, and Access The Dempsey Center provides a haven of support where anyone whose world is...Careers at the Dempsey Center
Join Our Team We are seeking candidates who are passionate about our mission, eager to support our clients, and who live and model our core values of compassion, teamwork, humility,...Clayton’s House Host (Client Facing Position)
Serve as “host or hostess” while providing a calming, supportive, neighborly presence – offering compassionate companionship to guests and caregivers.Dempsey Center + Cancer Resource Center of Western Maine Collaborative Programs
Cancer Resource Center of Western Maine Collaborative Programming To help even more people access no-cost support services throughout the state of Maine, the Dempsey Center has teamed up with the...Clayton’s House Provider Information + Referral Hub
Clayton’s House Provider Information + Referral Hub Forms for providers to complete to refer a client to stay at Clayton’s House, Dempsey Center’s healthcare hospitality home. Information About Clayton’s House...Program Submissions
Submit Your Program to the Dempsey Center We are so grateful for our partners and external providers who want to bring their skills, interests, hobbies, and expertise to help cancer...Clayton’s House Referral Form
Clayton’s House Referral Form for Application for Stay For completion by a clinical team member from the patients treating HealthCare Provider The Dempsey Center offers programming in Lewiston & South...
