Referral of Patients

Referral of Patients

To refer a patient, please fill out the form below. Our scheduling coordinator will contact your patient promptly.

First Name

Last Name

Contact Phone Number


Referring Physician Name

Is it an urgent consult that is required within one week

Reason for referral

Please do not submit any Protected Health Information (PHI).

** To refer a patient by phone, please have the information requested on the form available, so that we can enter it in our medical records system.

Participating Providers

  • AARP
  • Affinity (Pending)
  • Americhoice (United Health Care Community Plan)
  • AMERIGROUP (HealthPlus)
  • Blue Cross/Blue Shield
  • Cigna
  • Coventry
  • Empire/NYSHIP
  • Fidelis
  • GHI
  • HealthFirst
  • HIP (Note: We DO NOT accept HealthCare Partners)
  • MagnaCare
  • Medicare
  • NorthShore – LIJ (CareConnect)
  • Oxford Health
  • Tricare
  • United Healthcare
  • VNS
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We encourage you to contact us whenever you have an interest or concern about our services.
Please fill out the form below.