At Health Plus, our mission is to work to ensure that every child and adult in New York City and Nassau County has access to free and low cost healthcare.
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Referral Information and Forms

  • Health Plus Referral Form (for CHP, FHP and Medicaid members only) - ( PDF, 50KB)
  • Health Plus DM/CM Referral Form for disease or case management services - ( PDF, 110KB)
  • How to Refer a Member for Specialty Care (CHP, FHP and Medicaid only) - ( PDF, 81.4KB)
  • W-9 Form and Instructions - ( PDF, 326KB)
  • Health Plus Elite (Medicare) Referral Form - ( PDF, 40KB)
Note: To view documents in PDF format, you'll need Adobe Acrobat Reader. If you don't have it installed already, please click here to install.)

To save PDF file, right mouse click on link, select "Save Target As..." and choose location to save document.
Child Health Plus Family Health Plus Medicaid Medicare
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