Become our patient

Please note that we accept only patients age 10 years and younger.

If you would like your child to become our patient, then please complete the form below.

This is a secure form. You may enter confidential medication information on this form. For medical emergencies, do not use this form and call 911.

After completing this form, these are the next steps:

  1. We will call you to discuss the services we offer to ensure these are what you seek (you can also review our frequently asked questions list).
  2. We will send you a follow up email with additional details. This may take a few days. Please look for an email from
  3. We will send you an invitation to join Patient Ally which has secure online forms to gather your address, your insurance details, and your signature on various documents.
  4. You will then need to register for Patient Ally and complete our forms there. We have a guide for getting started.
  5. We need you to then send us a copy of the patient’s insurance card(s) using this secure link.
  6. If you do not already have access to your child’s account on the Mass General Brigham Patient Gateway, then you will need to complete this form (rules on access to a child’s account are described here). Send the form and a copy of your driver’s license to us using this secure link.
  7. Depending on your insurance, we may ask you to obtain additional documents from your child’s pediatrician, such as a referral or a prior authorization.
  8. You must complete steps 1-7 to be added to our wait list
  9. Once we have received all this paperwork, then our scheduler will contact you to schedule a series of up to four visits.
  10. Before the first visit, the doctor will usually request that you and your child’s teachers or caregivers answer some standardized questionnaires about your child using a service called CHADIS. We have a guide for using this questionnaire service.