Information for Referring Physicians

ReadyMED welcomes the opportunity to partner with you in the care of your patients when you are unavailable. In most cases, making a referral is an easy process, requiring you only to fax us the information below.

Date of Referral
Expected visit date (if different)
Patient Name
Patient DOB
Reason for Visit/Referral
Patient’s PCP
Referring Provider Name
Referring Provider Location
Referring Provider Phone

ReadyMED Fax: 508-792-1549

For your convenience, you can print the following sample referral form and fax it to us.

Click here for a sample referral form
You may download this version of the form and add fields that may be helpful to your practice.

Click here for a printable, non-editable pdf referral form

The following plans require payor approval. Please submit the appropriate referral request by the next business day.

Aetna HMO
BCBS HMO
BCBS Blue Choice
BCBS Network
BCBS Advantage HMO
Mass Health PCC
Tufts HMO
Tufts Medicare Preferred HMO
Tufts US Family Health

The following plans do not require payor approval; however ReadyMED is not in network. Patients may use their Out of Network benefit which may require a higher out of pocket expense for the patient.

BCBS Advantage PPO
Tufts Medicare Preferred PPO