FILL & SIGN APPLICATIONS ONLINE
For Online Application, you will need:
Participant Info, Insurance Info, and PCP Info - Please make sure you have the information handy when you start filling this form and e-signing it.
NOTE: Once you fill and sign the application, we will contact your PCP (Primary Care Physician’s Office) to get more information about your medical history and their approval to attend the adult day health program.
The system will also send you an email to confirm submission - Click on the link that comes to your email. Only then will the form get submitted to us. Please don’t hesitate to call us if you have questions - 781.757.2223.
OR DOWNLOAD THE FILLABLE FORMS BELOW - Fill, Sign, Scan and Email them back to us: info@happylifeadh.com
UPLOAD REQUIRED DOCUMENTS BELOW:
Upload the following docs using the form below:
1. Copy of your Insurance Card (Masshealth / SCO)
2. Copy of Passport or Green Card
3. Drivers License or State ID