Become a Patient

Appointments are available now. Please fill out the form below or place one convenient call to our Rehabilitation Solutions Call Center: 1 (800) 44-REHAB (73422) or (713) 797-5942.

The information collected in this form will be used to coordinate rehabilitation services for you or a loved one. The Rehabilitation Solutions Call Center schedules appointments for inpatient rehabilitation, outpatient medical clinic and outpatient rehabilitation.

Start the Process

5 Minute Form 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 a patient?

This form is intended to be used by individuals, family members, friends or caregivers looking to become a patient or help someone become a patient of TIRR Memorial Hermann. If you are a health care professional looking to refer your patient, please submit our Refer a Patient form.

Refer a Patient

Patient Information

First Name: *

Last Name: *

Address: *

Suite:

City: *

State:

Zip Code:

Country *

Email: *

Daytime Phone: *

Date of Birth:

Insurance:

I don't have Insurance

Is the patient in a hospital or medical facility?

Yes

Primary Contact Information

Primary Contact First Name: *

Primary Contact Last Name: *

Primary Contact Email: *

Primary Contact Phone Number: *

Relationship to Patient:

Referring Information

Referring Physician's Full Name:*

Referring Physician's Email Address: *

Referring Physician's Phone Number: *

How did you hear about TIRR Memorial Hermann?

I would like to receive news and information from TIRR Memorial Hermann

Thank
You!

We have received your request to join the TIRR Become a Patient. A team member will contact you shortly.

TIRR Memorial Hermann

TIRR Memorial Hermann Services

US News and World Report Best Hospitals Badge

Nationally Ranked Rehabilitation

For the 34th consecutive year, TIRR Memorial Hermann is recognized as the best rehabilitation hospital in Texas and No. 4 in the nation according to U.S. News and World Report's "Best Rehabilitation Hospitals" in America.

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