Requests and Forms — ADHD Boston

Online Forms for Current Patients

Refill Request

Please schedule a follow up visit before requesting refills if your last appointment was more than 6 weeks ago

Prescription Refill

Name

First Name

Last Name

Email Address

Medication(s) and mg (dose)

Pharmacy store name, address, zip code

Message

Schedule Online

Click to Schedule

Invoice Request

Insurance Request

Invoice Request

Client Name

First Name

Last Name

Email Address

Dates of Service

Message

Prior Authorization Request

Client Name

First Name

Last Name

Email Address

Medication needing authorization

Health Insurance

BCBS

Tufts

Harvard Pilgrim

United Healthcare

Other

My insurance is not listed and I have:

Member ID