New York Presbyterian

Forge Health and New York Presbyterian are partnering to provide evidence based mental health and substance use care for individuals, both in-person and virtually.
Please fill out the form below.

Upon submission, both you and the referred individual will promptly receive an email confirmation.

Forge Health will work directly with the client to coordinate a level of care assessment

Please provide your information:
Please provide us with the patient’s information:
MM slash DD slash YYYY
Patient Insurance information:
Forge Health partners with most major insurance companies. *Medicaid and Medicare are accepted at select locations.
If your insurance provider is not on this list, please select “Insurance Not Listed”
Your member ID can be found on your insurance card. If your member ID is alphanumeric, please include both the letters and numbers you see on your card.
Service Inquiry:
Is the patient interested in in-person or telehealth services?*
What is the patient's primary need?*
Which service(s) are you recommending for this patient?*
Supporting Clinical Documents (optional)
Max. file size: 256 MB.
Please include relevant medication information – specifically a current medication list (including doses) and medication allergies. Additional relevant information could include: most recent oncology note, medical/oncologic history, oncologist contact information, and behavioral health screening results (e.g., PHQ9, GAD7).”
Consent
I give or have obtained any necessary consent/authorization prior to disclosing the health information above. The patient is aware of this referral and is expecting Forge Health to contact them directly via phone, voicemail, SMS/text, and email as appropriate.*