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Refer a Patient
Get Started
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All Clients
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LGBTQ+
Veterans & First Responders
Partnerships
Resources
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Blog
News
Client Portal
Payment Portal
Client Resource Documents
Client Service Issue Resolution
Locations
Massachusetts
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New Jersey
New York
Pennsylvania
Refer a Patient
Get Started
New York-Presbyterian / Weill Cornell Psychiatry
Patient Referral Portal
Referrer information:
Your first name
*
Your last name
*
Your title/role
NYP / WCM Clinic Name and Location
Your phone
Your email
Patient information:
Patient's first name
*
Patient's last name
*
Patient's date of birth
*
MM slash DD slash YYYY
Patient's phone number*
*
Patient's email
*
Patient Address
*
Patient's State
*
-Please choose and option-
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Conneticut
Delaware
District of Columbia
Florida
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississppi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Patient's Zip Code
*
Patient insurance information:
Patient's Insurance Type
*
Commercial
Medicaid
Medicare
Self-pay
Other
Forge Health partners with most major insurance companies. *Medicaid and Medicare are accepted at select locations.
Patient's Insurance Provider:
*
—Please choose an option—
1199 NATIONAL BENEFIT FUND
AETNA
AETNA BETTER HEALTH – MEDICAID
ALLIED BENEFITS SYSTEMS INC.
ALLIED TRADES
AMERIHEALTH
AMERIHEALTH ADMINISTRATORS INC.
ANTHEM BCBS OF NH
BLUE CROSS BLUE SHIELD OF MASSACUSETTS
CARELON – PA MEDICAID
CARELON (EMBLEM-GHI-HIP)
CARELON (NYS EMPIRE PLAN)
CARELON / BEACON HEALTH OPTIONS
CHAMPVA
CIGNA
CORESOURCE – TRUSTMARK
EMPIRE BCBS
HARVARD PILGRIM HEALTH CARE
HEALTH NEW ENGLAND
HEALTH PLANS INC.
HEALTHSMART / WTC
HIGHMARK BCBS OF PA
HORIZON BCBS OF NJ
HORIZON NJ HEALTH – MEDICAID
INDEPENDENCE BCBS OF PA
MARTINS POINT HEALTH CARE
MEDICIAD – NEW HAMPSHIRE
MEDICIAD – NEW JERSEY
MEDICIAD – PENNSYLVANIA
MERITAIN HEALTH
NEW HAMPSHIRE BLUE SHIELD
OPTUM UBH
OXFORD
PRIMEX
TRICARE EAST
UMR
UNICARE
UNITED HEALTHCARE
UPMC
UPMC FOR LIFE – PA MEDICARE
UPMC FOR YOU – PA MEDICAID
UNION CONTRACT
VA COMMUNITY CARE
WEB TPA
INSURANCE NOT LISTED
If your insurance provider is not on this list, please select “Insurance Not Listed”
Patient's member ID:
*
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.
List Insurance Provider Here:
*
Please provide the name of your insurance company and upload images of both the front and back of your insurance cards.
How can we best support your patient?
What is the patient's preferred service delivery method?
In Person
Telehealth
What is the patient's primary need?
Mental Health
Substance Abuse / Addiction / Alcohol
Other
Which level of care are you recommending for the patient?
*
IOP (Intensive Outpatient)
OP (Outpatient)
Psychiatric Evaluation
Medication Management
Other
Tell us a little more about the patient and their current needs
Clinical documentation (as applicable):
Drop files here or
Select files
Max. file size: 5 MB, Max. files: 5.
Please include any current medications, psychiatric history, most recent clinical note, and PHQ9, GAD7 or any other available behavioral health screening inputs.
Location Preference:
Patient's Preferred Location for Services:
*
—Please choose an option—
Massachusetts – Virtual
New Hampshire – Manchester
New Hampshire – Virtual
New Jersey – Mahwah
New Jersey – Paramus
New Jersey – Princeton
New Jersey – Toms River
New Jersey – West Deptford
New Jersey – West Orange
New Jersey – Virtual
New York – Hauppauge
New York – Queens
New York – Syosset
New York – White Plains
New York – Virtual
Pennsylvania – Doylestown
Pennsylvania – Greensburg
Pennsylvania – Langhorne
Pennsylvania – Philadelphia
Pennsylvania – Virtual
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