Start Admissions Now

For your convenience, you may complete the form below at any time and Parker’s Admissions staff will contact you within 24 hours.

Please note that sending this form does NOT obligate you, and does NOT guarantee admissions.

For a complete list of Admissions Telephone Numbers, click here.


Your Name *

Your Email

Your Telephone Number *

Patient’s/Resident’s Name

Your Relationship to the Patient/Resident

Patient’s/Resident’s Present Location

Home (address)

Nursing Home




Seeking Admission For:
Short Term Rehabilitation
Sub-Acute Care / Post-Acute Care
Nursing Home
Parker on Madison - Social Adult Day Care
Home Health Care
Dialysis (provided by the Queens-Long Island Renal Institute, Inc.)
Not Sure/Other



271-11 76th Avenue, New Hyde Park, New York 11040-1433   |   Tel: 877-727-5373   •   718-289-2100   •   516-247-6500   |   Fax: 718-289-2245