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BriefMD Medical Office
Referral Requests

BriefMD Medical Office
1500 District Avenue, Burlington, MA 01803
Phone: 508-444-8851
Fax: 508-657-8338

Fill out the form below and click submit to request a referral.

Are you an organization or Facility Representative? if No, Call Office directly.
Do you need a referral for both Provider and Facility

This form is not for emergencies. For chest pain, severe shortness of breath, loss of consciousness, stroke-like symptoms, severe allergic reaction, or any life-threatening concern, call 911 or send the patient to the nearest emergency department.

Official use only

Reviewers start confirmation response forms here 
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Official use only
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