New Transferring-In Patients

Have you already confirmed we are IN-NETWORK with your insurance carrier? If not, please stop here and call your member services team on the back of your insurance card to assure we are in-network with your health insurance before continuing with the registration process.

 

If you wish to transfer your care to our practice, please complete the attached forms below. Once completed, please submit them back with a full copy of your child’s previous medical records and insurance card.

Attention to: Anesa Tmusic, New Patient Coordinator Atmusic@mgb.org

 

The current providers accepting new transferring-in patients:

Dr. Laurel Gaffin 

Dr. Tracey Daley 

Please note this does not apply to any NEWBORN patients. Please call our office for NEWBORN information.

• • • Patient Information Form
    • Insurance Waiver Form
    • Authorization for Vaccine Administration
    • Family History Summary
    • Medical History Form

(To expedite the registration process, please submit the New Patient Intake Forms, Insurance Card Copy, & Previous Medical Records from your child’s previous doctors office at the same time.)

We request that you obtain and provide a copy of your child’s previous medical records for our physicians to review prior to scheduling any future appointments. (This would include all previous office notes, immunization history, growth charts, lab results, medication list, etc.) This will afford you the best possible medical care. We must have your child’s previous vaccination records on file by the time of your visit. Ideally these will be submitted to us at the time of registration and prior to scheduling any appointments. Please note we cannot schedule appointments without the requested documents. .

Thank you for choosing Centre Pediatric Associates, PC.

View our insurance policies

We would like to make you aware that we do not accept the following insurances:

• BCBS- HUGH P *(unless prefix is #HUA)*
• BCBS- SELECT SAVER PLAN
• BLUE- HPN or BLUE- Select Network Plans
• BMC (Boston Medical Center)-ANY & ALL BMC PLANS NOT ACCEPTED
• BMC-MASSHEALTH
• CIGNA LOCAL PLUS / CIGNA LOCAL PLUS IN (eff:01/01/2018)
• FALLON-MASSHEALTH
• FALLON-DIRECT CARE
• TUFTS- SPIRIT PLAN
• TUFTS TOGETHER (eff: 03/01/2018)
• WELLSENSE-MASSHEALTH
• MASSHEALTH-STANDARD
• HPHC-Beth Israel Lahey Health Domestic & Community HMO
• HPHC QUALITY HMO (eff: 7/1/2024)