Application

Ready to Get Started?

To get your admissions process started, please complete the online form below. We’re looking forward to receiving your application!

Questions? Interested in scheduling a tour of our facility? Please call Sister Damian, D.M., our Director of Admissions at 717-755-1964.

NOTE: All fields marked with a RED asterisk are mandatory.

For your convenience, you can download, print, and complete the admissions application offline. When you are finished, submit your application via email to sdamian@mn-rc.org or via fax at 717-840-0010. 

You may also mail the application to Misericordia Nursing & Rehabilitation Center, ATTN: Admissions Director, 998 S. Russell Street, York, PA 17402

Download PDF Application

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Application for Admission

Thank you for your interest in Admissions at Misericordia. Please complete the form below and we will be in contact with you shortly. All fields with a RED asterisk (*) are required. Thank you.

Personal Data

Name*
Home Address*
Goal Related to This Admission:*

Now Residing At: (If different than Home Address)