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Forms & Documents

Required Forms                          

Complete Online or print PDF. If possible, complete these forms before you are seen as a patient.  

Concierge Medicine Agreement
(Founder's Membership)
PCB Consent for Treatment

If you are paying by Credit Card

PCB Credit Card Authorization Form

Printed & signed (or scanned) PDF forms can be

   faxed to:            617-263-0002

   mailed to:          3 Hawthorne Place, Suite 106,

                               Boston, MA 02114

   emailed to:        salone@prioritycareboston.com

Documents for Review               
Welcome Letter (Founder's Membership)
Communicating with PCB
HIPAA Privacy Notice 
Directions to MGH from PCB
ACH & Wire Bank Transfers
Health Status Assessment Tools
Physical Functioning
Lifestyle Review
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