It’s easy to enroll with ACANY to receive care coordination services.

There are two ways to start:

By Phone

To have an ACANY team member call you, please fill out this short form and we will contact you shortly.

If you have questions before you get started or need assistance, call us at:

(833) MY-ACANY or (833) 692-2269
Option #1

By Mail

  1. Please complete the Intake Form, Enrollment Checklist and appropriate Consent Forms for you or your loved one. Consent forms can be found below.
  2. Mail the form and completed documents to:

Advance Care Alliance of New York
1410 Broadway, 9th Floor
New York, NY 10018
Attention: Intake Department

Child (under18) Adult (18+)
Health Home Patient Information Sharing Consent Enrollment Form
Health Home Consent Information Sharing Form
Health Home Consent FAQ Form
Health Home Consent Enrollment Form