Patient Forms - New England Mothers First

All the forms you need for Mom and Baby

As Nurse Practitioners

We are Medical Providers

Please note, NEMF does NOT bill under YOUR Affordable Care Act (ACA) Lactation Benefit. All claims are processed through the medical insurances of both the Mother and the baby according to your health care plan design.

HMO & EPO policies will require a referral from the mother’s Primary Care Physician as well as the baby’s Pediatrician. Copays, Co-Insurance, and Deductibles may apply to services pending each individual mother and baby insurance policy.

We Service:
Braintree, Cambridge, Middleboro, Milton, New Bedford, Norwood, Quincy, Randolph, Walpole, Wellesley, Weymouth, West Bridgewater, Greater Boston and some parts of Cape Cod

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About Us

We are a small group of nurse practitioners who are committed to helping you and your family as you embark on your infant feeding journey. One of our providers of medical care will be assigned to care for you and your baby. We offer expertise compassionate and individualized care. We work closely with you through the early difficult weeks with the option of problematic follow up through the first year. We will work closely with you and your care team, your Pediatrician and OB Provider.

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Locations

Middleboro
Pediatrics
2 Lakeville Business Park
Lakeville, MA 02347
Phone: (508) 444-9456

Lower Falls
Pediatrics
65 Walnut St # 310,
Wellesley, MA 02481
Phone: (508) 444-9456

Pleasant Hill
Pediatrics
22 Pleasant Street 2nd Floor
West Bridgewater, MA 02379
Phone: (508) 444-9456

We Also Offer

Home visits
Telehealth visits

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Mothers Signature Form for Care

Notice of Privacy Practces for Protected Health Information (PHI)
Notice of Privacy Practces for Protected Health Information (PHI)Patient Consent and Notice Acknowledgment FormPractice Letter Overview with Financial ProcedurePrenatal Practice Letter (if applicable)

By signing here, you are consenting to treatment for all visits beginning with your first visit with New England Mothers First.

First Name*

Last Name*

DOB*

Electronic Signature*

This is for Consent of Photography and Data Collection*:

(This is separate from signature for consent to treat) (If any photo is collected, it is discussed again prior to utlizing any pictures or video)

Disclaimer: This consent form includes all medical visits, beginning with the ini:al visit, with New England Mothers First