OP Agency/Clinician 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 

We’ll respond to information received between 8 a.m. and 4:15 p.m., M-F, that same day.  We respond to off-hours information Mon.-Thurs. the very next day, and on Mondays to information received on weekends.

Patients Release of Information
Cover Sheet (patient demographics, including insurance)
Most Recent Evaluation and Treatment Records

 

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

 

 

YOUR PATIENT MUST CALL US AT:

 

TO SCREEN WITH US.
We will get back to you and your patient to arrange an onsite evaluation and admission to Tully Hill.