Golden Hill Application Request

Application Request

If you would like our admission application packet mailed to you, please complete the responses below.

First name
Last name
Street address
City
State
Zip Code
Phone
E-mail
Your inquiry is confidential. It will not be distributed or sold.

While you are awaiting the receipt of your application packet, please review the following list of items. These documents, along with a completed application, will be necessary if you choose to pursue admission to the Center:

A Patient Review Instrument (PRI)
A recent Medical Exam including Chest X-Ray and PPD test
Birth Certificate, baptismal or naturalization papers
Copy of Social Security Card
Copy of Health Insurance, Medicare, and/or Medicaid Card
Power of Attorney
Burial Fund Statement
Financial documentation supporting information provided on the application

You can mail or deliver the entire packet to:
Admission Coordinator, Golden Hill Health Care Center, 99 Golden Hill Drive, Kingston, NY 12401

Ulster County Home Page