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Choose a method to submit the referral documents. 

OPTION:

1. Electronic referral documents are accepted by the patient portal and secure email. 

   a. PORTAL: If you are a first-time user, you need to create an account to gain access. 

 The Patient Portal meets all HIPAA security expectations, and we guarantee that patient data will not be passed to third parties.  

To create a Patient Portal account, click the Patient Portal Login button below. 

Once logged in, select the "Forms to Complete" section to complete the Presence Referral Form and attach the supporting documentation. 

    b. EMAIL: info@presencedevelopmental.com

2. Paper referral documents are accepted by fax and mail. 

  a. FAX #: 315-515-5194 

    b. MAILING ADDRESS: 115 Fall Street, Seneca Falls, NY 13148

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REFERRAL DOCUMENTS:

1. Completed "Presence Referral Form"
2.  Copy of the Insurance card(s) -Front and back 
3. Copy of the most recent Life Plan
4. copy of the Individualized Education Plan (for school-age and if referral is for PT, OT, or SLP)
5. Completed Authorization for Release of Health Information to Presence
6. Script for evaluation (if for PT, OT, or SLP)
7. copy of the authorization for the Release of Health Information & the referred individual’s primary care physician.  (if for PT, OT, or SLP)

Please include the reason(s) for referral.

Presence will do our best to respond to your referral within 2 business days. 

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If you need immediate assistance:

• 911 for emergencies  
• 988 for mental health emergencies
• National Suicide Prevention Hotline (800) 273-8255
• Suicide Prevention Text Line 741741