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Do you know of healthcare resources that will help people living in Maine improve their health and stay well? KeepMEWell.org maintains a database of healthcare services in Maine that are offered at no cost or on a sliding scale.
Please complete the form below if your organization offers a no cost or sliding scale clinical service.
The form is reviewed for no cost or sliding scale criteria before being place in the database.
* Indicates that the field is required.
We will contact you if we need additional information and to let you know the status of your submission.
*Name:
*Telephone:
*Email:
The following information may be listed on the website.
*Name of organization:
*Name of program:
*Program Description:
* The following search terms are used on the website. Which of these terms best describes your services? Please check all that apply Medical Care Dental Care Prescription Drugs Mental Health Nutrition and Wellness Reproductive Health Immunization Substance Abuse Screening and Prevention Eligibility for Health Insurance
* Fee base for services: No cost Sliding scale Other
Other (please specify):
Eligibility criteria (This may include the specific population served by the program)
Physical Address 1 (Building):
Physical Address 2 (Street):
*City:
*Zip code:
*Main telephone number:
Operating Hours:
Contact person's name:
Contact person's telephone number:
Email address:
Web address:
Comments:
