Make a Referral to Nascentia Health

Home Care Intake Referral – new
Please select the type of service(s) you are requesting:
For questions and/or to check on an existing referral you can:

  • Call: (315) 477-4663
  • Encrypted email:
(include area code)
Upload referral information below. Here is what we typically look for:

  • Demographic Sheet
  • Current Medication List
  • Treatment Orders
  • History and Physical
  • Recent Visit Note including PT and / or Notes, if applicable
  • Immunization Records
Maximum upload size: 104.86MB
Unable to use our online resource? Referrals can also be completed by downloading the Referral Request Form (pdf), completing it in its entirety and either:

  • Encrypted email:
  • Fax: 315-477-9584