REFER A PATIENT BY FAX                                                                        203-288-8205

 

Refer a Patient for Home Care by Fax:

 

Download or request a copy of our Patient Referral Form (see below)

Fax form to our Intake Coordinator @ 203-288-8205

REFER A PATIENT BY PHONE                                                                  203-288-8200

 

Call Home Health Specialty Services, Inc. and speak to an Intake Coordinator. 


Please provide essential patient information, including:


- Name, Address and Phone Number
- Social Security number and Date of Birth
- Current insurance information, including Medicare
- Emergency contact information
- Ordering MD’s name
- Primary diagnosis and reason for referral
- Types of services required
- Recent medical history
- Current medications