Five Journeys Referrals
Please fill out the form completely and plan accordingly as it may take up to two weeks to obtain a referral.
Referrals to Five Journeys
To request a referral from your PCP to see our medical providers, please provide them with the following information.
Please fax the information to 617-934-6401.
If we do not receive this information before your first appointment, you will be charged for the visit and then reimbursed when the referral arrives. Thank you.
- The date of your first appointment
- Number of visits – 12
- The reason for your visit
- Our Fax # 617-934-6401
The name and NPI# of your provider:
- Edward Levitan, MD
- Wendie Trubow, MD
- Marinela Lavena, MD