Referral

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If you would like to submit a referral we need the following information:

1. Basic Patient Information (or fax face sheet 315.339.4134)

  • Name
  • Address & phone number
  • Insurance information
  • Diagnosis
  • Height and Weight

2. Type of Equipment

3. When Ordering Oxygen:

  • Sat % or ABG
  • Date Sat % of ABG was performed

4. Name of the Ordering Physician

5. Discharge Information

  • Date
  • Time
  • Room Number if Applicable

You are more than welcome to use your own form/face sheet etc. or you may use ours. Simply click here or find it under the "Rentals/Services" tab labeled "Intake/Referral"

Online Bill Pay

Qualify through insurance for a free breast pump. Call us for details. Rome: (315) 339-4084. Syracuse: (315) 475-5181.

Hours
Rome
M-F8:30 a.m.5:00 p.m.
Sat9:00 a.m.1:00 p.m.
SunClosed
Syracuse
M, W-F8:30 a.m.5:00 p.m.
Tuesday8:30 a.m.6:00 p.m.
Sat9:00 a.m.1:00 p.m.
SunClosed

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Certified Women Owned Business

NYMEP - New York Medical Equipment Providers Association

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