Request an Appointment

To request an appointment in this clinic, please first complete one of the following intake forms. We know that these forms might seem lengthy, but our medical team reads all of the information so that your time spent with us can be maximally efficient and productive. The form should take about thirty minutes to complete.

If your son or daughter is younger than 21 years old:

If your son or daughter is 21 years or older:

(If you are unable to complete one of these intake forms electronically, please contact our Program Coordinator, or 617-643-8912, to request a paper version.)


Please check with MGH Patient Insurance Services with any questions about your insurance. It is your responsibility to ensure your insurance will be accepted for the visit. Please contact them at: 617-726-2191.

Medical Records

If your son or daughter has received medical care from a health care provider outside Mass General, please use the release form below to request that medical records be sent to us in advance of your visit so that we can review them.

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