Kirkhaven Admission Information

We appreciate your interest in Kirkhaven,
in order for us to process an application, please:

  1. Request a PRI (Patient Review Instrument) and Screen completed by a local nursing agency or hospital social worker be sent to Kirkhaven by fax or mail.
  2. Complete an Application Form. Our financial worksheet is very straightforward and we do not require any additional documentation.
    Print & Complete Application Form
  3. Have the applicant’s primary care physician submit medical information by fax
    or mail. A Release of Health Information Form can be filled out by the applicant, applicant’s provider or facility to enable Kirkhaven to obtain the pertinent medical records.
    Print & Complete Health Information Release

When we have received all relevant data, the application will be reviewed by our Admissions Committee to determine whether Kirkhaven can meet the needs of the applicant.

Admission Agreement

Kirkhaven Fee Schedule 2021

If your need for placement is immediate, we urge you to stay in contact with us. If, after 30 days, all information has not been received we will assume you are no longer interested and the file will be closed. Files remain active as long as we continue to receive updated PRIs and Screens or contact is made every 90 days regarding your continued interest.

Tour Kirkhaven

Kirkhaven offers tours by appointment. We advise you to tour at your earliest convenience.

infoFor additional information, questions or to arrange a tour call:
Admissions (585) 461-1991, x3010