Request Home Visit Order

We are committed to providing specialized and complex wound care in the comfort of your home.

Advanced, physician-led wound care for complex and non-healing wounds—supporting visiting nurses, WOCNs, home health agencies, podiatrists, assisted living communities, and more to keep patients home.

New patients must be registered, the only way to register a patient is by Submitting a Case below.

Medicare and Most Managed Medicaid Plans Accepted

Self-Pay Options (Call Us For Pricing)

📞 Helpline

516 - 919 - 4321

General Questions?📧 Email Us
- For meFor someone else
- YesNo
- Referring Organization/Facility/Physician *
- What is your relationship to the patient?*
- What is your name?*
- Referring Person or Organization Best Phone Number*
  Format: (000) 000-0000.
- What is your email*
- FaxEmailBoth fax and email
- Optional: where should we email care plan/progress notes?
- Optional: Where should we fax care plan/progress notes?
- Patient Details
- Please enter information carefully to avoid treatment delays, wasted time and unnecessary back-and-forth.
  
  Your browser may autofill fields incorrectly. Please verify every detail to avoid preventable delays.
- Patient Full Name*
  
  Last NameFirst Name
- Patient Phone Number*
  What is the best phone number to schedule care?Format: (000) 000-0000.
- Patient Date of Birth*
  
  MonthDayYear
- Wound Details
- Slow or non-healing woundPressure sore / bed soreSurgical or post-operative woundBurnInjuryOther / Not Sure
- Less than 2 weeks2–6 weeksOver 6 weeksIt’s been on and off for a whileNot sure
- 3. Please describe the issue *
  The more details the better.
- YesNoNot sure
- Optional: Attach/Use Camera images of wound(s), If available, recommended.
  
  Please ensure photos are well-lit and in focus. You can upload mutliple images.
  Cancelof
- Location & Living Situation
- YesNoNot sure
- Caregiver, Attendant Phone Number (If available)
  Please enter a valid phone number.Format: (000) 000-0000.
- No, patient resides in a private home.Yes
- 8. Name of Facility/Community
- 9. Patient Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- 10. Optional: Apartment/Room Number
- Medical & Insurance Information
- 11. Please list any medical conditions the patient has or you are aware of (e.g., diabetes, high blood pressure, asthma). If none or unknown please type: No known medical conditions.*
- YesNo
- 12. Primary Insurance Provider *
  To verify coverage please enter the patient’s Medicare number. All Medicare recipients have a government-issued 11-character Medicare ID.
- 12a. Primary Policy Number*
  .
- 13. Secondary Insurance Provider
  Leave blank if no other or secondary insurance.
- 13a. Secondary Policy Number
  Leave blank if no other or secondary insurance.
- Q26. Optional: Patient face sheet,(demographics) prescription etc. If available, recommended.
  
  Cancelof
- Q27. Optional: Comments (Private Pay? Please provide the name and phone number of the person we should contact to discuss billing)
- Authorization & Consent
- Yes I agree with the above statement.
- 🌟 What Care Professionals Are Saying About Specialty Wounds:
  
  👩‍⚕️ Home Health Agency (HHA)**
  
  “I’ve ran a home health agency for over 10 years, and I’ve never worked with a wound care team this responsive. I send in the referral, and my patient is seen within a day. The staff are kind, professional, and always explain the plan so I can help between visits. It makes my patients — and me — feel supported.”
  
  Denise R., HHA, Brooklyn, NY
  
  🏠 Certified Home Health Agency (CHHA) Nurse Supervisor**
  
  “Partnering with Specialty has improved our wound healing outcomes tremendously. The communication is excellent — Our nurses trust them completely.”
  
  Maria L., RN, CHHA Supervisor, Long Island, NY
  
  🩺 Housecall Physician
  
  "As a housecall doctor, I depend on reliable wound care specialists who understand the urgency of treating chronic wounds. Specialty Wounds has become my go-to partner. They see patients quickly, provide thorough assessments, and their follow-up reports are top-notch. They’ve become an essential part of my practice.”
  
  Dr. David K., Housecall Physician, Northern NJ
  
  👩‍💼 CHHA Administrator
  
  “Before we started using SpecialtyWounds.com, scheduling wound care visits was a constant headache. Now our patients get seen within 24 hours — sometimes the same day — The families notice the difference, and our rehospitalizations are down.”
  
  Karen P., Administrator, Bronx, NY
- Yes, it’s getting worseNo, it’s stableNot sure
- Should be Empty:

Patient Details

Wound Details

Location & Living Situation

Medical & Insurance Information

Authorization & Consent