Specialist Referral Form for Referrals outside the MassGeneral Brigham Network
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If you or your child are a patient of Patriot Pediatrics, and your doctor has recommended seeing a specialist inside of the MassGeneral Brigham (MGB) system, then the insurance referral will be processed automatically. If the specialist is outside of the MGB system, then please call (781) 960-1204
and have the following information available:
Patient's Name; Date of Birth; Telephone; Insurance Company; Policy Number; Suffix; Primary Care Doctor's Name, Specialist name; Specialist Address, Telephone; Fax; NPI Number (Please ask the specialist when you make the appointment); Appointment Date; Reason for Visit
Patient's Name; Date of Birth; Telephone; Insurance Company; Policy Number; Suffix; Primary Care Doctor's Name, Specialist name; Specialist Address, Telephone; Fax; NPI Number (Please ask the specialist when you make the appointment); Appointment Date; Reason for Visit
The referral staff will be happy to assist you.