To make a referral, please click the link below. You will then be directed to our secure portal, Clinic Tracker, where you can create an account for self referral or to refer individuals you are working with. We have included the pdf below to take you through the process step by step. If you need assistance, please feel free to email us at firstname.lastname@example.org or call us at 315-515-5183. We look forward to receiving your referral.
To make a paper referral, please click the link below. Please complete the referral form and send with the attachments to:
Fax to (315) 515-5194
115 Fall Street Seneca Falls, NY 13148
Email securely using your secure email service to : email@example.com
We will contact you once we receive your referral. We look forward to receiving your referral.
Please include the Required Eligibility documentation with the completed Referral form:
1. Evidence of OPWDD Eligibility
2 Copy of ALL current Insurance card (s) (front and back).
· If copy of cards not possible, provide details of insurance coverage on the Presence Referral form.
· If Medicare Advantage, or 3rd party Medicare, please provide us with that information.
· If Medicaid Managed Care plan, please provide us a copy of this card.
3. Current Life Plan, IEP and other plans of care.
4. Individual signed authorization consenting to the release of PHI to:
A. Presence Counseling Services (Social Work Service) and/ or
B. Presence Developmental Services
(Behavioral Support, Psychology, Sexuality assessment and training,
specialty services, Occupational, Physical Therapy, or Speech Language Pathology services).
Additional Referral documents for PT, OT & SLP service requests:
A. Individual signed authorization CONSENTING TO the release of PHI between PDS & the individual’s primary care physician &
B. Prescription for PT, OT or SLP services
If you have any questions please email firstname.lastname@example.org
or call (315)-515-5183.