Click the form you need to fill out below:
Update my contact info
Legal Name Change or Pronoun Update
Sign a Release of Information
Update My Insurance Information
Change my credit card or HSA/FSA on file
ADHD Cash Waiver Form
Divorced and Separated Parents Form
Request a Refill of a Prescription
Cancel My Scheduled Appointment
Contract for Controlled Medications
Privacy and Consents Form
Telehealth and Electronic Communications Consent
Patient Positive Experience and Complaint Form
Medication Management Intake Form
ADHD testing Intake Form
For a description of each of these forms please scroll down below. All of our forms are electronic, protected by encryption, and are HIPPA compliant. Your privacy is a top priority.
Use this form to update your contact information including phone, email, or address:
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 Information 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. Click the link below to start the form.
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 24 business hours in advance (excluding weekends and MA state holidays) to ensure that your plan can be accepted and to prevent you from incurring the full cost of the visit. Those Cancelling their appointment with less than 24 hours notice may incur a missed appointment fee. All information entered will be encrypted for your privacy and is HIPAA compliant. Click the link below to start the form.
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 full card number. All information entered will be encrypted for your privacy and is HIPAA compliant. Click the link below to start the form.
This form indicates you either understand your insurance is unwilling to cover ADHD testing or you are choosing to opt out of using your insurance and agree to self pay for this service.
This telehealth consent forms allows you to select or update your telehealth and electronic communication preferences with our office. This form is encrypted for your security and is HIPAA compliant. Click the link below to start the form.
For parents and guardians that are legally required to share medical decision making for a minor or disabled patient, this form helps us understand preferences about parent/guardian attendance at appointments and obtain treatment consent.
The patient experience and complaint form allows patients to express both positive experiences as well as concerns or complaints about their experiences at BPC. Patients may choose to identify themselves or write anonymously if they prefer.
Notes on Privacy:
Please note that BPC has no ability to protect your information if you decide to download , print , email , or share it in some other way than through our encrypted form/link. Once you perform any of these actions you are assuming the risk that your information may not be protected. To keep your information protected, only use the electronic forms via the links provided.