Download Mid-Coast Connector forms here.
Please note that all forms are in PDF format. If you do not have a PDF reader you can download one for free here: Adobe Reader
Self Drive/Family, Friends and Neighbor Mileage Reimbursement Form. Click here to download.
Use this form to record mileage information from driving to scheduled appointments. Once you have submitted the form to us we will verify the information and forward you payment. If you have frequent appointments, you are welcome to fill in fields that will always be the same and make copies to save time. Please remember that you will always need to fill in mileage and date information for each appointment and that we need original signatures from your medical provider's office and from you in BLUE ink to process payments.
Consent Form for Children under 16 Traveling without Escort. Click here to download.
Use this form if you are a parent of guardian of a child under the age of 16 who needs to travel without an escort. Mid-Coast Connector must be in receipt of this signed form prior to any travel of children under the age of 16 who travel alone.
Direct Deposit Form. Click here to download.
Use this form to request that Mid-Coast Connector deposits mileage reimbursement funds directly into your bank account rather than sending payments via paper checks.