Admissions Process

We appreciate your interest in Kirkhaven. In order for us to process an application, please:

REQUEST

Request a PRI (Patient Review Instrument) and Screen to be completed by a local nursing agency or hospital social worker and sent to Kirkhaven by fax (585-461-9160) or email.

COMPLETE

Complete an Application Form. Our financial worksheet is very straightforward and we do not require any additional documentation.

SUBMIT

Have the applicant’s primary care physician submit medical information by fax (585-461-9160) or email. A Release of Health Information Form can be filled out by the applicant, the applicant’s provider, or facility to enable Kirkhaven to obtain the pertinent medical records.

• Application Form
• Release of Health Information Form
• Admission Agreement
• Kirkhaven Fee Schedule 2023