Forms

INTAKE PAPERWORK:

For patients who have already had contact with our intake coordinator and have been cleared to make an appointment please follow the link below to fill out intake paperwork. Do not fill out the Intake document if you have not been instructed to do so. Please be aware that clicking this link will direct you to AdobeSign to complete your paperwork. All information entered will be encrypted for your privacy**.  Please remember to verify your email after completing your document to finalize your form.

Start the Intake

RELEASE OF INFORMATION FORM:

To authorize Boston Psychiatric Care to release your protected health information to a particular person, health care provider, hospital, or agency please click below to sign a Release of Infomation document. Please remember that you may retract a release at any time you choose by requesting to Boston Psychiatric Care that you no longer authorize this individual, hospital, or agency. By Clicking the link below you will be directed to AdobeSign All information entered will be encrypted for your privacy**.  Please remember to verify your email after completing your document to finalize your form.

Start The Release Form

Change My Credit Card on File:

If your Credit, Debit, HSA, or Flex Spending card information has changed or needs to be updated, Please follow the link below to securely update this information. Please note that you will receive a call to verify your card number. All information entered will be encrypted for your privacy**.  Please remember to verify your email after completing your document to finalize your form.

Change My Card

Update My Insurance Information on File:

If your insurance has changed, please complete the following form by clicking on the link to update your information. Please keep in mind Boston Psychiatric Care cannot accept all insurance plans.  Please check with us at least 48 business hours in advance to ensure that your plan can be accepted and to prevent you from incurring the full cost of the visit. All information entered will be encrypted for your privacy**.  Please remember to verify your email after completing your document to finalize your form.

Change My Insurance

**Please note, if you decide to email your information to yourself or others, to print it, to save it to your computer, or to take a screen shot, we can no longer attest to the privacy and security of your data and you will assume the risk of these actions. All information entered into the forms on the AdobeSign platform will be encrypted for your privacy. **

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