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    • All Programming
    • Online with Dempsey Connects
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    • Rock Row – Westbrook, Maine
    • Public Workshops
    • Calendar
  • Services
    • Clayton’s House
    • Counseling
    • Education
    • Bodywork
    • Movement and Fitness
    • Nutrition
    • Support Groups
    • Wellbeing Support
      • Comfort Care Items
      • Dempsey Dogs
      • Wigs and Headwear
    • Youth and Family Services
    • How To Begin
  • Support
    • Donate
      • Honor or Memoriam Gifts
    • Volunteer
    • Share Your Story
    • Other Events
      • Drive Fore Kids
      • Sugarloaf Charity Summit
  • Dempsey Challenge
    • 2025 Event Details
    • Run, Walk, or Ride
    • Register
    • Donate
    • Login
    • Amanda Dempsey Award
  • About
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    • Financial Transparency
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Dempsey Center›Registration Forms›Client Registration Form – Non-Maine

ON DEMAND REGISTRATION FORM

Thank you for telling us about yourself. This information is used to help the Dempsey Center develop and schedule services for you. Please note, you must complete registration paperwork (including an Acknowledgment of Privacy Policy) before you can access Dempsey Center services. All responses are strictly confidential.

I am registering with Dempsey Center because:(Required)

INFORMATION

Name(Required)
Address(Required)
MM slash DD slash YYYY
Are you under the age of 18?
If under 18, guardian name:
Email(Required)
You will also be added to our email list, you can unsubscribe at any time
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OK to leave a voice or text message?(Required)
Preferred method of messaging:(Required)
Emergency Contact:(Required)
Information regarding Employment and Health Insurance is gathered solely for Dempsey Center grant application and funding purposes. Employment status and/or insurance coverage have no impact on one’s ability to be a client at the Dempsey Center. We will never contact your employer or insurer on your behalf, nor will we submit insurance claims for clients. All personal information provided will be kept confidential.
Employment Status:
Health Insurance Status:
Please provide information about your or your loved one’s cancer diagnosis
Treatment Status(Required)
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month/year
Type(s) and date(s)

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Dempsey Center Code of Conduct

Please review our Code of Conduct here… Dempsey Center Client Code of Conduct
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Find Us

Lewiston
29 Lowell Street
Lewiston, ME 04240

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 7:00 PM
Wed: VIRTUAL ONLY (8:00 AM - 5:00 PM)
Thurs: 8:00 AM - 5:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Rock Row - Westbrook
11 Rock Row, Suite 410
Westbrook, ME 04092

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 5:00 PM
Wed: 8:00 AM - 5:00 PM
Thurs: 8:00 AM - 7:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Find Us

Lewiston
29 Lowell Street
Lewiston, ME 04240

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 7:00 PM
Wed: VIRTUAL ONLY (8:00 AM - 5:00 PM)
Thurs: 8:00 AM - 5:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Rock Row - Westbrook
11 Rock Row, Suite 410
Westbrook, ME 04092

1-877-336-7287

Hours:
Mon: 8:00 AM - 5:00 PM
Tues: 10:00 AM - 5:00 PM
Wed: 8:00 AM - 5:00 PM
Thurs: 8:00 AM - 7:00 PM
Fri: VIRTUAL ONLY (8:00 AM - 12:00 PM)
Sat-Sun: Closed

Donations

Donations may be mailed to:
Dempsey Center
PO Box 277
Auburn, ME 04212
Checks should be made out to the Dempsey Center, please do not mail cash.
EIN Number: 82-1547129

Presented in part by

Donations

Donations may be mailed to:
Dempsey Center
PO Box 277
Auburn, ME 04212
Checks should be made out to the Dempsey Center, please do not mail cash.
EIN Number: 82-1547129

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