Request Care in 4 Easy Steps

Pre-Authorize Payment of Virtual Consult Fees

    Please complete the form below to request care from a licensed medical provider in Maine. This information is used by the medical provider to review your request and provide a care recommendation.

    1. Choose Pharmacy

    Enter your Zip Code to find a pharmacy.

    « Cancel


    Your Selected Pharmacy
    You can change your selected pharmacy later.

    2. Patient Information

    3. Patient Health Information

    Controlled substances cannot be prescribed through Push Health.

    4. Confirm Request and Agree to Terms

    After you submit your request, a licensed medical provider in your area will review your information. You will be notified by email when that provider has reviewed your request and, if appropriate, made care recommendations.

    By clicking the "Submit Request" button below, you indicate that you, as the patient or legal guardian of the patient, agree to the Terms of Service and Consent to Telehealth.