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Physician Access Intake Form (Providers + Staff Only)

Referring a patient has never been easier. Simply fill out our refer a patient form and one of our referral coordinators will immediately follow up with you. Having trouble? No problem. Just call our Adult Physician Access Line at 617-636-7255 or our Pediatric Physician Access Line at 617-636-1440.
In the case of a medical emergency, please call 911 for immediate assistance.

Department of Psychiatry

Tufts Medical Center
800 Washington Street
Pratt Building, 2nd floor
Boston, MA 02111

  • Ph: 617-636-0219
  • Fx: 617-636-4852
  • Inpatient Admissions
  • Ph: 617-636-8935
  • South Boston Behavioral Clinic
  • Ph: 617-268-1700

* Indicates a required field.


Patient Information

Marital Status
Interpreter Required?

Insurance Information