Current Patients — ADHD Boston

Current Patients

We've created the forms below for our clients to initiate these requests easily.

Refill Request

Prescription Refill

Name

First Name

Last Name

Email Address

Prescriptions

Prescription Name and Dosage

Pharmacy Name and Address

Message

Invoice Request

Invoice Request

Client Name

First Name

Last Name

Email Address

Dates of Service

Provider

Dr. Thor Bergersen

Julia Volynskaya, LICSW

Megan Greene, LICSW

Message

Insurance Authorization Request

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

Schedule Online