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For Health Care Professionals

Referral Forms

Our simple and intuitive referral process allows you to quickly secure high-quality VNSNY care for your patients without time-consuming paperwork. Please choose the forms you need:

VNSNY Physician Referral with FFEVNSNY Physician Referral and Face-to-Face Encounter Form (FFE)

This combined form allows you to make a referral for VNSNY home care services as well as document an encounter between you and your patient related to their need for home care and their medical qualification as homebound.

If you need only the Face-to-Face Encounter (FFE) form, you can download a stand-alone FFE form.

Hospice Referral FormVNSNY Hospice Referral Form

To make a referral to VNSNY Hospice and Palliative Care, call 1-212-609-1900 or complete and fax a referral form to 1-212-290-1825.

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