Client Forms
New clients are invited to complete several forms before therapy begins. To make the process as smooth and efficient as possible, we provide documents as downloads here on our website.
Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either by fax (+1 617- 463- 9412) or as a scanned PDF file via
e-mail (doctor@elizabethwillems.com). All forms are also available by logging in to the client portal once your provider
has activated them.
If you are unsure which forms to fill out, we welcome you to contact us.
Release of Information
Authorization to Disclose Medical Records
Authorization to Disclose Medical Record[...]
Adobe Acrobat document [140.2 KB]
Authorization to Disclose Medical Records
Authorization to Disclose Medical Record[...]
Adobe Acrobat document [140.2 KB]
Good Faith Estimate (GFE)
You have the right to receive a Good Faith Estimate (GFE) explaining how much your medical care will cost. Healthcare providers and facilities are required to give patients who do not have insurance or who are not using insurance (self-pay) an estimate of the bill for medical items and services. This estimate is provided in writing when services are scheduled or requested.You can ask your healthcare provider for a GFE before you schedule an item or service.If you receive a bill that is 7$\$400$ or more than your Good Faith Estimate, you have the right to dispute the bill. For additional information visit this site: https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate#:~:text=If%20you%20lose%20your%20estimate,estimate%20before%20you%20get%20care.
GFE (revised on Nov 2025).pdf
Adobe Acrobat document [158.7 KB]
You have the right to receive a Good Faith Estimate (GFE) explaining how much your medical care will cost. Healthcare providers and facilities are required to give patients who do not have insurance or who are not using insurance (self-pay) an estimate of the bill for medical items and services. This estimate is provided in writing when services are scheduled or requested.You can ask your healthcare provider for a GFE before you schedule an item or service.If you receive a bill that is 7$\$400$ or more than your Good Faith Estimate, you have the right to dispute the bill. For additional information visit this site: https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate#:~:text=If%20you%20lose%20your%20estimate,estimate%20before%20you%20get%20care.
GFE (revised on Nov 2025).pdf
Adobe Acrobat document [158.7 KB]
Formularios
Les invitamos a los nuevos clientes completar varios formularios antes de que puedan comenzar la terapia u evaluacion. Para que el proceso sea lo más fluido y
eficiente posible, proporcionamos los documentos más importantes como descargas aquí mismo en nuestro sitio web.
Descubra qué formularios debe enviar, seleccione el enlace de descarga apropiado y devuelva los documentos completos a nuestra práctica por fax (+1 617-463-9412)
como un archivo PDF escaneado por correo electrónico (doctor@elizabethwillems.com). Todos los formularios también están disponibles iniciando sesión en el portal del cliente una vez que su proveedor
los haya activado.
Si no está seguro de qué formularios completar, no dude en contactarnos.
Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.
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