Get Access to Our Forms and Documents for New and Existing Patients

English

Haitian Creole

Spanish

Forms for New and Returning Patients

Patients can request forms from their providers by mail, fax, and drop-off.

Mail: Codman Square Health Center, 637 Washington St, Dorchester, MA 02124

Fax:

Internal Medicine: 617-825-7118
Family Medicine 2: 617-822-8225
Family Medicine 3: 617-822-8222
Pediatrics: 617-822-8206

Drop-off: Codman’s front lobby has a drop box.

Medical clearance forms take 3-5 business days to complete. All other forms take 5-10 days to complete.

Health Center staff will notify you when your forms are ready.

New Patient Demographic form

Walk-In Patient Request form

Frequently Asked Questions

How often do the bills come out from Codman to patients?

Patient statements are issued on a weekly basis for any new patient responsibilities that have been identified within the previous week. For accounts with balances less than $25.00, additional statements are issued every five weeks. For accounts with balances of $25.00 or more, if the patient has not paid the balance by the time the next statement is due, the account is referred to our reminder agency, which then begins a series of letters and calls reminding them that their balance is overdue. No additional statements are sent out.

Have questions about your bill? Call (617) 822-8257.

How do I fill a prescription?

Your provider can send an electronic prescription to the pharmacy located on the ground floor of the Health Center. You can pick up your prescription prior to leaving the Health Center. You can also get your prescription called in to an outside pharmacy as long as you bring the phone number with you.

Check with your insurance company to see if your prescriptions are covered by your policy. If they are, you may be restricted to certain pharmacies and you may need to make a co-payment.

We also have a prescription refill phone line you can call for refills: (617) 822-8371.

What insurance do you accept?

Visit our Health Insurance page to see a full list of all the Health Insurance Providers we accept.

Who owns the Health Center?

Codman Square Health Center is an independent facility managed by a community Board of Directors. This allows our community to make the decisions regarding the services we offer.

What are your hours?

Our hours of operation may vary between departments, but our standard hours can be found here and at the bottom of your screen.

Become a Patient

At Codman Square Health Center, you get exceptional, personal care from a specialized, multilingual care team. Our convenient resources include an extensive list of primary, specialty, and preventive care services. Call our Patient Service Center at 617-825-9660.

Become a Patient

Forms & Documents

Forms for New and Returning Patients

Related Links

Frequently Asked Questions

Become a Patient

Forms & Documents

Forms for New and Returning Patients

Related Links

Frequently Asked Questions

Become a Patient

Find a Provider