Refer a Patient

Children are eligible for care up to the age of 18 if, in the opinion of our physicians, there is a reasonable possibility they can benefit from the specialized services available. Applicants are accepted based solely on a child’s medical needs.

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

The service area of Shriners Hospitals for Children® includes the United States (including Puerto Rico), Canada, the Republic of Panama and Mexico. As of April 2009, we are temporarily not accepting new patients residing outside of these areas.

Download an application for treatment:

Application for Treatment and Application Instructions (pdf) (English)
Application for Treatment and Application Instructions (pdf) (Spanish)
Application for Treatment and Application Instructions (pdf) (Russian)
Application for Treatment and Application Instructions (pdf) (French)

Canadian hospital only French or English

Applications 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 800-237-5055. (In Canada, call 800-361-7256.) Completed applications should be returned to the nearest Shriners Hospital for Children.

Notice of Privacy Practices:

English
Spanish
Russian
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.

Physician Referrals

If you are a physician, and want to refer a patient to a specific Shriners Hospitals for Children®, please go to that hospital’s page and follow the physician referral process under the Apply for Care section. For more general information on referrals, or for help choosing a specific hospital, call 800-237-5055 in the U.S., or 800-361-7256 in Canada.

Application Procedures for Emergency
Burn Care

The sooner a child with burn injuries reaches
a Shriners Hospitals for Children 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
Hospitals for Children in Boston, Cincinnati,
Galveston or Northern California and indicate
that there is a patient needing emergency
burn care.

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

Boston: 800-255-1916
Cincinnati: 866-947-7840
Galveston: 409-770-6773
Northern California: 916-453-2111