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(973) 850-3121

New York workers’ comp & no-fault

Send a DME referral

One form for the whole intake — patient, attorney, provider, or adjuster. The Brooklyn desk reviews it the next business day.

How do I send a DME referral in NY?

Use the form below: the patient’s name, a phone number, and the equipment prescribed. Pick workers’ comp or no-fault — or “not sure” and we’ll help sort the claim path. A prescription is required — attach a photo or PDF right in the form, or send by phone or fax. We review referrals the next business day, then call with next steps.

Claim type
Who’s sending this referral?

Who’s this for?

What’s needed?

Whatever the prescription calls for — brace, CPM machine, cold therapy unit, TENS supplies, wheelchair…

Prescription required. If anything’s missing, we tell you exactly what to send.

No file handy? Send the referral now — fax it or ask for a secure upload link after.

How do we reach you?

The number we should call about this referral.

Prescription details, documents you’ll send — or ask for a secure upload link and we’ll reply with one.

We review referrals the next business day. $0 out of pocket where your claim applies and documentation is complete.

By submitting, you agree CityDME may contact you about this request. See our privacy policy.

Prefer phone or fax?

The desk takes the same referral over the phone during business hours.

Fax prescriptions and claim paperwork to (973) 846-7077. Need to send documents securely? Ask in the form notes and we reply with a secure upload link.

  • Next-day

    Referral review

  • WC + NF

    New York claim paths we handle daily

  • 5

    Boroughs served from Brooklyn

  • Rx-first

    Documentation confirmed before fulfillment