Request an Appointment

Created with Sketch.

Request Form

Please Note:

A completed form is neccessary to make your appointments for you and your baby.

If you are expecting, please complete the form and we will set up a prenatal visit at 34-36 weeks.

New Mothers click here for important information about your visit!


    Mother's information



    All MassHealth members should contact their plan to verify they have the correct PCP listed.

    Please Note: We register you as you're listed on your active insurance card.

    Are you the Insurance Subscriber? If not please enter in the comments below who is and the DOB. Thank you.

    *Required Field


    OB Doctor:


    Baby's information





    Information for us


     




     


    PLEASE EMAIL SNAP A PICTURE COPY OF YOUR INSURANCE CARD (FRONT AND BACK) ALONG WITH YOUR CELL NUMBER AND ADDRESS TO referrals@nemf1.com. Once your benefits have been reviewed we will contact you to discuss all options available to you and your baby.

    Note: When sending your card we need your address and a working phone number. - Thanks NEMF1 Team

     


    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.

    Created with Sketch.

    Website Designed and Developed by Lachance Web Design LLC