Forms
As many of you know, we recently switched our electronic medical record (EMR) system and need to update our database with the most current patient information. For existing patients only please fill out the
registration form
and return to us at least two days prior to your scheduled appointment or plan to come to your appointment 15 minutes earlier than scheduled. You can also fill out the form
securely online
. This form needs to be filled out for
ALL patients. You may list all children on the same form.
- Medical Record Release [ pdf ] then email, fax or mail in form.
- Our Financial Policy [ pdf ] [ secured online form ]
- Pre-Natal Registration
[ pdf ]
[secured online form]
- Authorization for Disclosure of Information Form [ pdf ] [ secured online form ]
- Behavioral Health Intake Forms and Initial ADHD Assessment Tools [ pdf ]
- Follow Up ADHD Assessment Tools [ pdf ]
We value the privacy and confidentiality of our adolescents and young adults. We have a consent form in the office for them to complete.
The HIPAA document below describes how medical information about you may be used and disclosed and how you can get access to this information.Please review it carefully. If you have any questions about this notice, please contact our Practice Manager at (617) 969-8989 .
7/2018 HIPPA- read-only
Download File
In order to view or print these forms, you will need Adobe Acrobat Reader installed.
Click here to download it.
Links
We as a practice believe that all children should be vaccinated according to the CDC and AAP guidelines for vaccination schedule. You may review it here: CDC vaccine schedule