You can choose to share your Mental Health and/or HIV information in one of the following ways:

  1. Return this form to your provider or a notary public, have them witness and forward to HealthInfoNet by fax at 207-541-9258 or mail to 125 Presumpscot Street Box 8, Portland, ME 04103.
  2. Contact HealthInfoNet at 866-592-4352 to schedule a time to come to HealthInfoNet’s office in person with your government-issued photo ID. HealthInfoNet is located at 125 Presumpscot Street, Portland.