Call Us Today: (978) 577-1946

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New Patients

If you are new to Westford Internal Medicine, please fill out the following forms and see our accepted insurances list to ensure coverage.

New Patient Forms

Accepted Insurance List

Need Health Insurance? Apply for health and dental insurance through the Massachusetts Health Connector at www.mahealthconnector.org. Be sure to check the list of insurances Westford Insurance accepts or call the office at 978-577-1946.

Additional Forms

Please fill out and bring in any additional forms below relevant to your visit.

Workers’ Compensation

Auto Liability and Personal Injury Protection (PIP)

Missed Cancelled Appointment Policy

Authorization for Release of Medical Information Form: To obtain or release your medical records. Please fill out this form if you are transferring to a new doctor, getting records from your previous doctor for WIM, or requesting records from the Emergency Department or a specialist.

Patient Representative Authorization Release Form: Please fill out this form if you would like a family member or friend to have access to your medical information. This form is needed if you would like someone to pick up prescriptions on your behalf, to speak with office staff regarding your protected health information, or to schedule or reschedule appointments. You can allow access to all medical information or just a specific amount for each individual listed on your form.