If you are a veteran living in Maine with symptoms of PTS(d) and/or traumatic brain injury, you are eligible to apply. Please choose and download one of the application formats below.
In addition, please have your medical practitioner complete the Medical Professional Referral letter and include it with your application:
Please complete application and EMAIL it along with a copy of your DD214 to firstname.lastname@example.org
If you prefer to use TRADITIONAL MAIL, please mail your application along with a copy of your DD214 to:
*Attendance at the retreat is not a substitute for any counseling or treatment in which you may be involved.
CONFIDENTIALITY STATEMENT: Consumer confidentiality is governed by many laws and regulations. These include: HIPAA (regulations at 45 CFR Parts 160 and 164), the federal law related to privacy of health information; Federal substance abuse law (regulations at 42 CFR Part 2); State mental health confidentiality law (34-B M.R.S.A. § 1207) and Community Service Network law (34-B M.R.S.A. § 3608); Federal protection and advocacy agency regulations (42 CFR Part 51); and State mental health confidentiality regulations (Rights of Recipients of Mental Health Services, Part A(IX) and Rules Governing the Disclosure of Information Pertaining to Mentally Disabled Clients).If there is a clear and substantial reason to believe that a consumer poses an immediate danger of serious physical harm to him/herself or others, providers must notify any person (including law enforcement and the endangered person) who may reasonably be able to prevent or lessen the threat.