Camelot Referral Form


Know someone who would benefit from our services? Complete our Camelot Referral Form and an Authorization to Release Information Form, and our Camelot Psyckes Consent Form then use the option below to upload these forms.  If you prefer, you can also email it to us at or fax it to 718-981-9344.

Downloadable Forms: Camelot Consent Form and Psyckes Consent Form



Complete our quick online referral form and a staff member will be in touch to provide/request further information.

  • Press The Shift Button To Make Multiple Selections
  • Please complete our forms above and upload them along with a physical exam and mental status form. If you prefer, you can also email these forms to or fax them to 718-981-9344
    Max. file size: 128 MB.

Contact Us:

Camelot of Staten Island, Inc.

Address: 4442 Arthur Kill Road, Suite 4

Staten Island, NY 10309

Phone: 718.356.5100