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:
- Submit the form below, including relevant details about the patient.
- Have the patient's current healthcare provider or case manager submit their medical records via the appropriate fax number displayed below.*
- Once we receive the patient’s documentation, we may perform an evaluation to determine if the patient is medically appropriate for Shepherd Center.
*If referring to MS, please also fax a referral from the current provider or case manager.
Before submitting the form below, please review our patient programs information 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
- 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 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.