Submit a Patient Referral Inquiry

Submission of this form represents an inquiry about referring an adolescent or adult patient to Shepherd Center. It is the first step in the online patient referral process, but not a formal referral. For both inpatient and outpatient referral inquiries received via this web page, Shepherd Center requires the following steps before the referral is formally reviewed.

1. Submit the form below, including relevant details about the patient.
2. Have the patient's current healthcare provider or case manager submit their medical records via the appropriate fax number displayed below.
3. Once documentation is received, an evaluation may be done to determine if the patient is medically appropriate for Shepherd Center.

Before submitting the form below, please review the patient programs information on the following web pages to make sure you are submitting an inquiry about the appropriate program.

• Spinal Cord Injury Program (inpatient and outpatient services)
• Acquired Brain Injury Program (inpatient and outpatient services)
• Outpatient Clinics
• Shepherd Spine and Pain Institute (outpatient only)
• Multiple Sclerosis Institute (outpatient only)
• Complex Concussion Clinic (outpatient only)
• SHARE Military Initiative (day program and outpatient services)
• Beyond Therapy (outpatient only)

Please note that Shepherd Center inpatient rehabilitation programs do not admit inpatients from home. If the patient is currently at home, please inquire about our outpatient services when completing the form below.

Also, Shepherd Center does not have contracts with Medicaid programs administered by states other than Georgia. Thus, treatment for patients with out-of-state Medicaid is typically not covered at Shepherd Center.

Due to capacity, Shepherd Center’s day programs for patients with spinal cord injury or brain injury are not accepting external referrals at this time. This does not apply to other outpatient services.