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

Is the patient currently receiving this kind of therapy or have they had this kind of therapy recently?
 
 

Preferred Rehab Location