Refer a Child for Care

at

the Shriner’s Hospitals for Children

To request as screening clinic for a child to be admitted to the Shriner’s Hospitals

Click on and complete the application(s) below save it to your PC and submit your application by the clicking the mailbox!

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Eligibility and Application

Children up to age 18 are eligible for care at Shriners Hospitals for Children if, in the opinion of our physicians, there is a reasonable possibility they can benefit from the specialized services available. Acceptance is based solely on a child’s medical needs. A family’s income or insurance status are not criteria for a child’s acceptance as a patient.

For patients at Shriners Hospitals for Children, ability to pay or insurance coverage is never an issue. all services are provided regardless of a patient’s or their parents’ ability to pay for the services that they receive within Shriners Hospitals for Children facilities.

Application Procedures for Orthopaedic Care, Spinal Cord Rehabilitation, Cleft Lip and Palate Repair and Non-Emergency Burn Care

Download an application for treatment in English, Spanish ,French (Canada residents only), or Russian. Forms can also be obtained from any Shriner or Shrine Club; by writing to Shriners Hospitals for Children, P.O. Box 31356, Tampa, FL 33631; or by calling the Shriners Hospitals (800) 237-5055. (In Canada, call (800) 361-7256.) Completed applications should be returned to the nearest Shriners Hospital for Children.

Application Help

Application Help (English)   Application Help (Spanish)  Application Help (Russian)  Application Help (French)

For information about a completed application or for other questions, please e-mail patientreferrals@shrinenet.org, or call (800) 237-5055 or (800) 361-7256 in Canada. Both lines are staffed weekdays between 8 a.m. and 5 p.m. EST.

Application Procedures

for

Emergency Burn Care

The sooner a child with burn injuries reaches a Shriners Hospital that specializes in burn treatment, the better the chances of recovery.  In an emergency, the referring physician treating a child with burn injuries should telephone the chief of staff at the Shriners Hospital in Boston, Cincinnati, Galveston or Sacramento and indicate that there is a patient needing emergency burn care.

The telephone numbers for emergency admissions Shriners Hospitals specializing in burn treatment are:

• Boston: (800) 255-1916
• Cincinnati: (800) 875-8580
• Galveston: (409) 770-6733
• Sacramento: (916) 453-2111

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If you are not sure which hospital is closest to you, please call toll-free (866) 714-7123.

Transportation issues are handled on a case-by-case basis. The hospital’s care coordinator will assist families with transportation details.

* Note all communications will be considered confidential in accordance with Federal H.I.P.P.A. Regulations and information will only be disclosed as necessary to qualified medical personnel in relation to obtaining admission to the Shriners Hospitals for Children.

Notice of Privacy Practices:

Spanish
Russian
French