Provider Referral | Birthing Gently

MassHealth Provider Referral Form

Referring Provider Name

Referring Provider Email

Referring Provider Phone

Patient First + Last Name

EDD required

Patient Email

Patient Phone

Language Spoken

URGENT REFERRALS:

Providers can make referrals for patients admitted onto the L&D floor. Please fill out the form and TEXT or CALL 978-314-5533 to let us know you made a last-minute referral.

POSTPARTUM REFERRALS:

Providers can make referrals for patients who have already delivered and did not utilize the prenatal or birth Doula services. MassHealth covers 8 perinatal visits that can be used postpartum. Please note our postpartum visits are virtual check-in sessions. Please submit the referral form and check “postpartum service” only.