If you are a physician, hospital, physician’s office, case manager, assisted living community, skilled nursing facility, or other healthcare provider looking to refer a patient, we’d be happy to assist.
Please call our office at (973) 320-7317 to discuss the referral with a member of our intake team.
For your convenience, our Referral Intake Form is available for download below. Once completed, you may submit it by:
📧 Email: info@kinetichometherapy.com
📠 Fax: (973) 860-1332
When faxing a referral, please include:
– Patient Face Sheet
– Demographic Information
– Insurance Information (front and back of insurance cards, if available)
– Physician Prescription or Referral (if applicable)
– Relevant Medical Records, Progress Notes, or Hospital
– Discharge Summary (when available)
Our team will promptly verify the patient’s insurance benefits, coordinate any required documentation, and contact the patient to schedule an evaluation.