Provider Contact – New York Presbyterian Hospital

Thank you for thinking of The Renfrew Center for your patient. To facilitate a smooth and efficient referral process for NewYork-Presbyterian providers and their partners (Weill Cornell, Columbia), we have outlined the necessary information required to ensure your patient receives the appropriate care in a timely manner. Our goal is to make this as quick and seamless as possible, allowing you to easily provide the needed details.

Next steps: Renfrew’s Program Information Department will be in touch to schedule an assessment with the referring provider/case worker if the patient is currently in a partial or inpatient program, or directly with the family if the referral is coming from the ER. Renfrew is in network with most major providers, including Fidelis for all levels of in-person and virtual care. Benefits will be verified independently for each patient.

Below is a list of the required documentation and forms to help expedite the referral and admission. Should you have any questions or require assistance at any stage, Christen Murray, LPC, LMHC, Residential Admissions Manager, is here to support you every step of the way and can be reached at [email protected].

You can also contact the Professional Relations Representative for your region. For our Westchester program, reach out to Gina Lavorgna, MPH, at 203-918-4466 or [email protected]. For our New York City program, contact Emily Gold at 646-599-7789 or [email protected].

We appreciate your partnership and look forward to working together to provide the best possible care for your patient.

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Patient Information

Name *

Full Name

Date of Birth (DOB): *

Location *

City State ZIP Code

Is the Patient Aware of This Referral? *

Yes

If a minor, are parent(s)/guardian(s) aware of referral? *

Yes

If under 18: *

Full Name (Parent/Guardian)

Phone *

(Patient or Parent/Guardian)

Email *

(Patient or Parent/Guardian)

Referral Information:

Staff Member Making Referral

Full Name

Staff Member Phone

Staff Member Email

Renfrew Program / Level of Care Referring To

Date / Timeframe of Requested Admission

Preferred Method of Contact

Best Time to Contact You

Insurance Information:

Insurance Provider Name

Policy Holder Full Name

Full Name

Policy Holder’s Date of Birth *

Relationship to Patient

Policy Number

Group Number

Insurance Provider’s Phone Number

Type of Plan

Clinical and Medical Information:

Please fax the following documents to 215-482-5463. While these documents aren’t required to be submitted now, sharing them can help us ensure a smoother referral process for your patient.

Psychiatric Evaluation
Biopsychosocial Evaluation
Risk Assessment
Clinical Progress Notes
Nutrition Assessment
Meal Plan/Completion Records
Growth Charts
History/Current Height, Weight, and Vitals
History and Physical
Medical Progress Notes
Special Consultation Note
Allergy List (including any available allergy testing)
Lab and Test Results (including EKG)

28331

Reach Out to Us

Call 1-800-RENFREW (736-3739)

Talk with a Program Information Specialist at the number above to learn more about our
services and to schedule an assessment. Or, fill out the information below and we will contact you.