5 Shrewsbury St, Ste D
Holden MA, 01520
Next to Rite Aid & Dunkin Donuts
OPEN 7 DAYS
Save time in the waiting room! Find our patient forms here to complete before you come in.
Just open, print, fill out and bring it with you to your visit.
Please note that we require all patients or guarantors to provide all valid government issues photo ID and proof of insurance at initial time of registration. We also require patients to previde their required co-payments at time of service.
- NEW Adult Patient Registration Form (18+ years)
- NEW Pedatric Patient Regstration Form (up to age 17)
- Existing Patient Registration Form (18+ years)
- Existing Pediatric Patient Registration Form (up to age 17)
- Medical Record Request / Disclosure of Protected Health Information
- Motor Vehicle Accident Form
- Notice of Privacy Practices (NPP)
- Worker's Compensation
We Accept Most Insurance Plans
We are proud to be a participating and contracted in-network facility for following plan members:
- BeHealthy Partnership
- Blue Cross Blue Shield of
- BMC HealthNet Plan
- CeltiCare Health Plan
- CHP / Consolidated Health Plans
- Fallon Health
- Harvard Pilgrim Health Care
- Health Plans, Inc.
- HNE / Health New England
- MassHealth Standard
- Medicare B
- NHP / Neighborhood Health Plan
- Tufts Health Plans
- UMR / United Medical Resources
- UniCare (GIC State Indemnity Plan)
- US Family Health Plan
The following MassHealth plans are accepted and require a referral prior to being seen.
- Community Care Cooperative (C3)
- Partners HealthCare Choice
- Primary Care Clinician (PCC) Plan
- Steward Health Choice
Call to speak with one of our exceptional staff members should you have any questions.