Tully Hill®

Hospital Referral – Step 2

 

The uploading, storage, and access of your records is completely secure

and 100% HIPPA-compliant.

 

Having JAVA or FLASH running on your device will better ensure successful execution of your Upload 

 

Patients Release of Information
Cover Sheet
(patient demographics, including insurance)
Hospital Records

 

Can’t upload your file(s)? Fax them
to us at 315-413-5106 (e-fax)
or 315-696-8509

 

DONE


 

YOUR PATIENT MUST CALL US AT:
(315) 696-6114 or (800) 456-6114 / extension 122, 126, or 127
TO SCREEN WITH US.
We will get back to you and your patient to arrange an onsite evaluation and admission to Tully Hill.