Tully Hill

Medical Referral – Step 2

 

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

and 100% HIPPA-compliant.

 

Patients Release of Information
Cover Sheet
(patient demographics, including insurance)
Current or Most Previous Visit 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.