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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.

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 physician or health care professional looking to refer your patient, please click the button below to submit our Refer a Patient form.


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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.

Patient Information

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Contact Information Same as Patient

Referring Information

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