To make a referral please:
- fill out and submit the form below OR print and fax this form
- along with screenings and medication lists
to the attention of Georganna Koppermann, Military Liaison at 860-445-3010.
You can also call her with the information at 860-235-5570 or 800-832-1022.
Please note: All information is held in the strictest of confidence. Any information sent over the Internet is secure and encrypted. We do not sell any personal information. If you or someone in your care needs immediate assistance please call the facility for help or dial 911 in an emergency.
