Submit an Admissions Inquiry to Shepherd Center

Please note: This is not an official referral.

This form initiates an admissions inquiry with Shepherd Center, empowering patients and caregivers to evaluate whether we are a good fit for their rehabilitation needs.

Should you have any questions, please don't hesitate to reach out to us at 800-743-7437.

Asterisk (*) indicates required.

Requested Service

To learn more about how to become a patient at one of our outpatient programs or clinics, visit our outpatient admissions page.

Relationship to Patient

Healthcare professionals can initiate patient referrals at any time through the following methods:

Contact us directly at 404-350-7367, Monday through Friday, between 8:00 a.m. and 4:30 p.m. ET. Our team is available to discuss your patient's needs and determine their eligibility for admission.
Utilize a web-based referral management system such as CarePort or Ensocare.
Fax the referral directly to 404-603-4504.

Still have questions? Submit an admissions inquiry directly through our website.

Patient Information

First Name

Last Name

Phone Number

Email Address

Date of Birth

What is your current location?

Facility Name

Please Note: Shepherd Center does not admit inpatients directly from home. If you are currently at home, we encourage you to explore our outpatient services.

Other, please specify:

Are you presently located in the United States?

City

State

Country

City

State or Province

Other, please specify:

Date of Injury/Onset of Illness

Primary Insurance Provider

Please Note: 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 without a single case agreement.

None of the above, please specify:

Questions or additional information you'd like to provide

How did you hear about Shepherd Center?

Other, please explain:

Caregiver Information

First Name

Last Name

Phone Number

Email Address

Patient Information

Patient First Name

Patient Last Name

Patient's Date of Birth

What is the patient's current location?

Name of Facility

Please Note: Shepherd Center does not admit inpatients directly from home. If the patient is currently at home, we encourage you to explore our outpatient services.

Other, please specify:

Is the patient presently located in the United States?

City

State

Country

City

State or Province

Other, please specify:

Patient's Date of Injury/Onset of Illness

Patient's Primary Insurance Provider

None of the above, please specify:

Questions or Additional Information You'd Like to Provide

How did you hear about Shepherd Center?

Other, please explain: