Patient Resources

New Patient Forms

• Patient Registration Form
• Medical History Form
• Patient Financial Policy & Notice of No Show/Late Cancellation Fee Form
• Assignment of Benefits Form
• Communication Consent Form (optional)
• Permission to Treat Minors (if applicable)
• Notice of Privacy 

Other Patient Forms

• Permission to Treat Minors
• Release of Medical Information
• Short-Term Disability Consent Form
• Baby Photo Authorization Form
• Emerson Hospital Birth Certificate Registration
• Communication Consent Form

Billing & Insurance

• Patient Financial Policy
• Contact our billing department at 978-371-0302 x 202
• We accept most major insurance plans including the following:
  • Aetna
  • Blue Cross Blue Shield
  • Cigna
  • Fallon with Atrius ACO
  • Harvard Pilgrim Healthcare
  • Mass General Brigham Health Plan
  • MassHealth
  • Medicare
  • Tricare
  • Tufts
  • Tufts Public Plan
  • United Healthcare
  • HMA Administrators
  • PHCS

Laboratory Services at Concord OB/GYN

Laboratory services are provided by Emerson Hospital for you convenience on site at Concord OB/GYN.  All lab work, pap smears and pathology specimens are processed by Emerson Hospital who will submit a claim to your insurance for the processing of your specimen.

Ultrasound Services at Concord OB/GYN

For your convenience, ultrasound services are performed by a Premier Ultrasound Services certified sonographer and are available on site in our Concord location.  Ultrasounds are billed in two parts, the technical component (certified sonographer performing your scan) and the professional component (the radiologist interpreting the images and creating a report for your provider at Concord OBGYN).  Concord OBGYN will submit a claim to your health insurance for the technical component of your ultrasound.  The images taken at your ultrasound exam are read by radiologists at either Schatzki Associates, Inc radiology group or Dr. David Rose of NorthBridge Imaging (for pelvic ultrasounds) or Boston MFM - Tamara Takoudes, MD (for obstetrical ultrasounds) who will submit a claim to your health insurance for the professional component of your ultrasound.  

Helpful Links

• ACOG.org - for Patients – American Congress of Obstetricians & Gynecologists
• Mothertobaby.org - A trusted source of evidence-based information on the benefit or risk of medications and other exposures during pregnancy and while breastfeeding
• EmersonHealth - Find Help - Find information about financial assistance, food pantries, medical care, and other free or reduced-cost services in your area.
• Women, Infant & Children Nutrition Program (WIC) - A Massachusetts nutrition program that provides healthy foods, nutrition education, breastfeeding support, and referrals to healthcare and other services, free of charge, to Massachusetts families who qualify.
• FirstConnections.org – A non-profit, family support organization providing comprehensive services to families with infants & young children in metro-west communities.
• ImmunizationForWomen.org – Flu Season Immunizations
• La Leche League – Breastfeeding support & information for mothers
• Mayoclinic.org 
• Womenshealth.gov – Empowering women to live healthier lives.

Patient Portal

Communicate using our secure patient portal.