Submit a Patient Referral Inquiry

Submitting this form initiates a referral inquiry for an adolescent or adult patient to Shepherd Center. It is the first step in the online patient referral process. It is not a formal referral.

Before formally reviewing a referral, Shepherd Center requires the following steps for both inpatient and outpatient referral inquiries.

Patient Referral Process:

  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 we receive the patient’s documentation, we may perform an evaluation to determine if the patient is medically appropriate for Shepherd Center.

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

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 this form.

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.

Also, due to capacity limits stemming from the COVID-19 pandemic, Shepherd Center is not accepting external referrals to its spinal cord injury outpatient, single-service therapy program at this time .

Please complete the following steps to begin the referral process:

  • Complete this form, providing as much of the requested information as possible.
  • Click “Submit Inquiry” to have your message sent to Shepherd Center’s Admissions Department.
  • Work with your doctor or case manager to complete the referral process.

Records should be faxed to the Shepherd Center Admissions Department at 404-603-4504.

Records should be faxed to the Beyond Therapy program at 404-367-1227.

Records should be faxed to the Complex Concussion Clinic at 404-603-4422.

Records should be faxed to the MS Institute Admissions Department at 404-603-4517 or email MSNewPatientCoordinator@shepherd.org.

Records should be faxed to the Shepherd Center Admissions Department at 404-603-4509.

Records should be faxed to the Shepherd Center Admissions Department at 404-603-4509.

Records should be faxed to the Shepherd Center Admissions Department at 404-603-4509.

Records should be faxed to the Shepherd Center Admissions Department at 404-603-4509.

Records should be faxed to the SHARE Military Initiative Admissions Department at 404-603-4419 or email shareadmissions@shepherd.org.

Records should be faxed to the Spine and Pain Institute at 404-603-4418.

Referral Information

MM/DD/YYYY

Your Information

Patient Status

Referring Provider

Additional Information

Please fax the patient’s medical records to Shepherd Center via the program numbers listed below:

  • Spinal Cord Injury (inpatient) at 404-603-4504
  • Spinal Cord Injury (outpatient) at 404-603-4509
  • Brain Injury (inpatient) at 404-603-4504
  • Brain Injury (outpatient) at 404-603-4509
  • Complex Concussion Clinic (outpatient only) at 404-603-4422
  • MS Institute (outpatient only) at 404-603-4517
  • Spine and Pain Institute (outpatient only) at 404-603-4418
  • Beyond Therapy (outpatient only) at 404-367-1227
  • SHARE Military Initiative (outpatient only) at 404-603-4419

Download this PDF file to get a checklist of additional information needed for the referral process.