For families, patients, and facilities

Request care

Tell us what you need in plain words. A real person from our intake team will call you back to talk it through. If it is urgent, skip the form and call us right now at 201-568-3781 (NJ) or 718-834-1911 (NY).

Who is this request for?

A family member Myself A facility or organization

Your name

Phone

We call rather than email for anything time-sensitive.

City and state where care is needed

When do you need it?

Best time to call you back

How can we help? (optional)

General terms are plenty. The details come later, by phone.

For your privacy, please do not include medical conditions, diagnoses, or insurance details in this form. We go over care needs, insurance, and payment together on the phone, person to person, so nothing sensitive ever sits in a web form. How we handle what you send.

A Samaritan Services nurse sitting with a client in his home

What happens next

Our intake team calls you back. We listen first, then walk through care options, insurance and payment, eligibility, and scheduling, all on that call.

A note on eligibility

For certified home health care, a physician must authorize the plan of care. We accept private pay and referrals from Managed Long Term Care and Certified Home Health Care Agencies in New York.

Referring someone?

Case managers, discharge planners, and family friends refer people to us. Use this same form or call the office nearest you.