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Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

You can request medical forms in two ways- either by calling your clinician’s office or visiting our Patient Portal. To register for the Portal during your next visit ask the receptionist for a Personal Identification Number. From there you can go online and request an appointment, prescription refills, referrals, access your lab results and more.

Download Patient Forms

To view the forms listed below, you will need Adobe Reader. Please bring your completed forms with you to our office at the time of your visit.

Medicare Annual Visit Forms

Other Forms


Medical Records Requests

Pentucket Medical contracts with Sharecare Health Data Services to handle all requests for medical record copies.

To obtain a copy of your medical records from Pentucket Medical, please print and complete the forms above.  Completed forms must be sent to Pentucket Medical for validation by our office staff; you may mail it in or fax it to 978-469-5395.   After your information has been validated, we will send your request to Sharecare and they will process your request.

Once Sharecare has processed your request, they will send your records via first class U.S. Mail or via e-mail with instructions detailing how to access the records electronically.

If you have any further questions about Sharecare Health Data Services, you may contact them at or call 800-560-3800. If you want to track the status of your request once submitted, please visit their website at and click on Record Access and Record Status https://recordstatus.


Pentucket Medical has remained committed to ensuring the safety of our patients during the COVID-19 pandemic.

Since June 1, we have been treating patients on-site per the four-phase guidance issued to healthcare facilities by Governor Baker and the Massachusetts Department of Health and Human Services.

In the coming weeks, we will continue following stringent infection prevention processes and implementing specific precautions to ensure a safe environment for essential patient care services.

Here are some of the changes you will see on your next visit to Pentucket Medical:

When scheduling an appointment with a clinician, you will be provided a phone number to call when you arrive at the office this will allow you to remain safe in your car until it is time to see your provider essentially cutting out waiting rooms

We appreciate your support.


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