300 Longwood Avenue Boston, MA 02115 (617) 355-6000 Clinical Services (Dentistry): For Providers Treatment referral form (for physicians and dentists) If you are a physician and would like to refer a patient to us, please complete our Patient Referral Form. Online form Complete and submit online. or   Paper form (pdf) Print it, fill it out and fax it to 617-730-0478. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. Copyright © Children's Hospital Boston. All rights reserved.