Tully Hill

Medical Practice / Healthcare Professional Referral Form

If you can’t use the form below you can print out, complete, and send us our Medical Practice Healthcare Professional Referral Form via e-fax (315) 413-5106 or main fax (315) 696-8509.

YOUR PATIENT MUST CALL US AT: (315) 696-6114 or (800) 456-6114 -- extension 122, 126, or 127.

We will then finish our admission pre-screen with your client (we will need to obtain from him or her additional medical information, treatment and medication history, and employer and any past or pending legal information) and get back to you if we have any questions, or need more information.