Childrens Hospital Primary Care Center (CHPCC) | Physical forms and other forms

If you need a form for school, camp or perhaps a nurse at your child’s school to have authorization to dispense a medication your child needs regularly please use the forms below. We also offer online forms for Massachusetts utilities that may need to be notified about your child’s needs that would be impacted by an electricity or heat discontinuation (Utilities request) below. We already have the fax numbers and addresses for all utilities in Massachusetts so you do not need to provide those to us.

If you need a prescription refill you will need to call us at 617-355-7701.

Please give us 5-7 (business) days to get any form ready for delivery. Most forms can be done without a visit, but if your child is overdue for a visit we may ask you to schedule an appointment before we can fill out the form.

Completed forms may be faxed, mailed or picked up at our registration desk and can be indicated on the Letter and Authorization to Dispense forms below. For the digital forms below, once the form has been faxed, mailed or is ready for pickup, a confirmation email will be sent to you indicating your request has been fulfilled.