Referral Forms

Provider Information:

WNY Integrated Care Collaborative offers regional evidence-based CHOOSE HEALTHY WNY and CHOOSE HEALTHY WNY with DIABETES  programs which have been proven to improve patient compliance with their healthcare provider instructions and improve health outcomes - such as:

  • Weight loss
  • Better controlled blood sugars
  • Better pain management
  • More confidence in managing their conditions
  • Better communication with providers
  • Reduction in Falls
  • Better management of depression

We accept referrals from Providers for patients into our programs and will provide you with a letter of their progress and outcomes from their participation in our programs.


Our Current Programs accepting referrals:

CHOOSE HEALTHY WNY - an evidence-based group "self-management" workshop providing participants tools to help manage their chronic conditions.  Past participants have enjoyed great outcomes!

CHOOSE HEALTHY WNY with DIABETES - an evidence-based group "self-management" workshop providing participants tools to help manage their diabetes.  Program is Supervised by Registered Dietitians and Registered Nurses.  *Eligible participants with Medicare are able to receive Individual Medical Nutrition Therapy with a Registered Dietitian before, during and after the group workshop.


WNY Integrated Care's Chronic Care Management (CCM) Program - providing health coaches and care coordination for patients with multiple chronic conditions.  Piloting this program now.

CHOOSE HEALTHY WNY with CHRONIC PAIN - an evidence-based group "self-management" workshop providing participants tools to help manage chronic pain.

CHOOSE HEALTHY WNY in the WORKPLACE - an evidence-based program specifically designed to be held in the workplace with 2 (1 hour) sessions per week for 6 weeks.  Employers report improved attendace and better employee health.

Frequestly Asked Questions:

Do the CHOOSE HEALTHY WNY Programs replace existing programs and treatments?

The programs do not conflict with existing programs or treatment. Treatment is not altered. For medical questions, participants are referred to their physicians or diabetes educators. If the content of the workshop conflicts with instructions they receive elsewhere, they are advised to follow their physicians' orders and discuss discrepancies with the physician.

How can a Physician submit a referral for a patient to attend the program?

Providers can securely fax a referral for their patients into the program through our secure fax number:

  • Erie County - Secure Fax: 716-858-6468 c/o CHOOSE HEALTHY WNY, Janice Nowak
  • Niagara County - Secure Fax: 716-278-1936 c/o CHOOSE HEALTHY WNY, Kris Wolf

Click here (REFERRAL FORM) for a printable version of Diabetes Self-Management Referral Form.


Great video for Providers interested in offering the program for their patients:

Subjects covered include:

  1. Techniques to deal with the symptoms of diabetes, fatigue, pain, hyper/hypoglycemia, stress, and emotional problems such as depression, anger, fear and frustration;
  2. Appropriate exercise for maintaining and improving strength and endurance;
  3. Healthy eating
  4. Appropriate use of medication; and
  5. Working more effectively with health care providers. Participants will make weekly action plans, share experiences, and help each other solve problems they encounter in creating and carrying out their self-management program. Physicians, diabetes educators, dietitians, and other health professionals both at Stanford and in the community have reviewed all materials in the workshop.

Each participant in the workshop receives a copy of the companion book, Living a Healthy Life with Chronic Conditions, 4th Edition, and an audio relaxation cd.*

It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants' confidence in their ability to manage their health and maintain active and fulfilling lives.

EMAIL Nikki Kmicinski (Director of Business Development) with any questions: [email protected]