東部地區轉介包
Individuals served in Cayuga, Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates counties should use the East Region Referral Form.
All individuals will need to read the HIPAA Notice of Privacy Practices and sign an Authorization for Release of PHI and Acknowledgement of Notices and Privacy Practices. Please save these items and open them using Adobe Reader or a similar product. Continue scrolling for additional information.
Please watch the video provided for more information on consent form completion.
一旦表格完成並簽名，它們可以直接通過電子郵件發送到intake@personcenteredservices.com或傳真到（716） 671-2175。他們也可以發送，連同一個自位址的蓋章信封的人中心服務，接收部，1090A聯合路，套房260，W.塞內卡，NY 14224。
收到所要求的資訊后，招生專家將伸出援手，開始協助您辦理入學和入學手續。
請填寫並提交以下表格：
您可以參考下面的範例填寫確認和授權：