Health Forms

Printable Versions

Health Form
Instructions
CMMC Pharmacy / Bates College Delivery Request Form Print, Complete, and Sign.

If you are interested in having your prescriptions delivered to Bates College where you can pick them up at Post and Print, fill out the following form and simply send it to us by one of two methods:

Attach it Electronically to our Online Form: If you don’t have it electronically you can use your phone/tablet to take a snapshot of it and attach that to our online Form.

Mail to:
Bates Health Services
31 Campus Ave.
Lewiston, ME 04240

Authorization for Release of Student Health Information Print, Complete, and Sign.

This form is to request the release of your health information from Bates College to you, your parents, and/or legal guardian(s). This forms also serves as a release to authorize the providers and/or other third parties listed on the form to verbally communicate, send and/or receive the medical information listed in Part III on the form to the Bates College Health Services. Send it to us by one of two methods:

Attach it Electronically to our Online Form:If you don’t have it electronically you can use your phone/tablet to take a snapshot of it and attach that to our online Form.

Mail to:
Bates Health Services
31 Campus Ave.
Lewiston, ME 04240

CMMC Pharmacy Patient Demographic Form Print, Complete, and Sign.

This information is requested by CMMC Pharmacy so we can provide appropriate pharmacy services to you. Fill out the following form and simply send it to us by one of two methods:

Attach it Electronically to our Online Form: If you don’t have it electronically you can use your phone/tablet to take a snapshot of it and attach that to our online Form.

Mail to:
Bates Health Services
31 Campus Ave.
Lewiston, ME 04240

Credit Card Authorization Form Print, Complete, and Sign.

CMMC Pharmacy accepts MasterCard and Visa (including debit cards and/or health plan benefit “benny” cards which have the MasterCard or Visa designation)(“Credit Card”) for the payment of fees incurred at CMMC Pharmacy. Fill out the following form and simply send it to us by one of two methods:

Attach it Electronically to our Online Form: If you don’t have it electronically you can use your phone/tablet to take a snapshot of it and attach that to our online Form.

Mail to:
Bates Health Services
31 Campus Ave.
Lewiston, ME 04240

Have Questions? Need Help?

Please feel free to contact us either by email, healthservices@bates.edu, or by calling 207-786-6199.