Now Serving Communities in MetroWest Boston, Rhode Island, and Eastern Connecticut
Get Started
Our Program
Learning Center
About Us
♥ Join Our Team!
Patient Portal
Get Started
Get Started
Tell us a bit about yourself, and when you're available for a visit.
Patient Information
Patient First Name
*
Patient Last Name
*
Patient Date of Birth
*
Patient Grade Level
*
Elementary School (K-5th grade)
Middle School (6-8th grade)
High School (9-12th grade)
Other
Sex Assigned at Birth
*
Male
Female
Intersex
Rather not answer
Patient Gender Identity
Man
Woman
Nonbinary
Transgender
Your Relationship to the Patient
*
I am the patient's mother
I am the patient's father
I am the patient's guardian
I am the patient
Preferred Braver Office Location
Billing
Insurance
Self-Pay
Name of Insurance Company
*
Member ID / Policy #
*
Insured's Relationship to Patient
*
Insured is the Patient's Parent
Insured is the Patient
Insured is the Patient's Spouse
Insured First Name
*
Insured Last Name
*
Insured Date of Birth
*
Insured Sex
*
Male
Female
Account Information
What are you seeking help for?
*
How did you learn about Braver?
*
Pediatrician
Friends & Family
Other healthcare provider
School
Online (web search, advertisement, etc.)
Health Insurer
Employer or workplace
Other
Create Password
*
Confirm Password
*
Your password will be used to login to the patient portal.
Submit
Ready to Participate?
Get in touch with us to discover if Braver's treatment program is right for you and your family.
Get Started
