The information collected in this form will be used to coordinate rehabilitation services for your patient. The Rehabilitation Solutions Call Center schedules appointments for inpatient rehabilitation, outpatient medical clinic and outpatient rehabilitation.
This form will take 5 minutes to complete.
TIRR Memorial Hermann accepts most insurance.
We will respond within the next business day.
Fields with an asterisk (*) are required.
Looking to refer someone you know?
This form is intended to be used for physicians and health care professionals referring patients to TIRR Memorial Hermann. If you are an individual, family member, friend or caregiver, please click the button below to submit a Become a Patient form.
For the 32nd consecutive year, TIRR Memorial Hermann is recognized as the best rehabilitation hospital in Texas and No. 2 in the nation according to U.S. News and World Report's "Best Rehabilitation Hospitals" in America.Learn More