Dempsey Center›Registration Forms

Welcome to the Dempsey Center

Forms to complete during the Dempsey Center Orientation process or upon accessing particular services for the first time.

Welcome Forms

Welcome Form – Maine Client

For new clients that are Maine Residents.

Get Started

Welcome Form – Non-Maine Client

For new clients that live outside of Maine.

Get Started

Acupuncture Forms

Acupuncture Guidelines

Form for clients interested in accessing acupuncture services.

Complete Form

Informed Consent – Acupuncture

For clients accessing acupuncture services.

Complete Form

Medical History Form

For clients accessing Dempsey Center services.

Complete Form

Adult Counseling Forms

Informed Consent – Counseling

For clients accessing adult counseling at the Dempsey Center.

Complete Form

Informed Consent – Youth + Families

For families accessing youth services.

Complete Form

Telehealth Consent – Counseling

Form for clients accessing adult counseling services virtually.

Complete Form

Clayton’s House Forms

Guest Application for Stay

To be completed after a referral for stay has been accepted.

Get Started

Care Partner Application for Stay

To be completed after a referral for stay has been accepted.

Get Started

Application for Independent Stay

To be completed after a referral for an independent stay has been accepted and approved.

Get Started

Massage Forms

Massage Therapy Guidelines

Form for clients interested in accessing massage therapy services.

Complete Form

Informed Consent – Massage Therapy

For clients accessing massage therapy services.

Complete Form

Medical History Form

For clients accessing Dempsey Center services.

Complete Form

Movement + Fitness Forms

Telehealth Consent – Support Services

Form for clients accessing support services virtually.

Complete Form

Medical History Form

For clients accessing Dempsey Center services.

Complete Form

Nutrition Forms

Telehealth Consent – Support Services

Form for clients accessing support services virtually.

Complete Form

Medical History Form

For clients accessing Dempsey Center services.

Complete Form

Reiki Forms

Reiki Guidelines

Form for clients interested in accessing reiki services.

Complete Form

Medical History Form

For clients accessing Dempsey Center services.

Complete Form

Youth + Family Services Forms

Informed Consent – Youth + Family

Parental consent for families accessing youth services through Healing Tree.

Complete Form

Telehealth Consent – Youth + Family

Form for clients accessing counseling services virtually.

Complete Form