Children’s Healthcare Of Atlanta

Request a Rehabilitation Appointment

Your privacy is very important to us. To help protect your privacy we provide this notice explaining our online information practices and the choices you can make about how your information is collected and used by Children's Healthcare of Atlanta.

After you submit this online form, our rehab scheduling department will call you within two business days to confirm your child’s appointment.

A written order/prescription from your referring physician is required for all outpatient rehabilitation services. You or your physician’s office can fax the order to the rehabilitation scheduling department at 404-785-7113.



 

Visit / Procedure Information

   

Preferred appt. date (if available)

 

Referring Physician's First Name

 

Referring Physician's Last Name

 

Phone Number

. .  

Pediatrician's First Name

 

Pediatrician's Last Name

 

Phone Number

. .  

If your child needs more than one therapy, please select Multiple Therapies

Rehabilitation Options

Complaint/ Diagnosis

  
 
   

Preferred Rehab Location

 

 

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