Nascentia Community Care Referral
Please complete the referral form below to help us understand the patient’s complexity and care needs. This information helps our team determine the next steps for optimal care.
Please provide any records from the past year, including diagnosis list/ICD-10 codes, office notes, labs, medication list, and any diagnostic testing, along with the completed referral form. We will follow up with you if we are able to accept the patient referral.
Questions? Please call us at (315) 641-2385.
Prefer to use the PDF referral form?
Download the referral form and return it by fax to (315) 305-4677 or email to article28@nascentiahealth.org.
Complete the Online Referral Form
All required fields must be completed before submitting the form.