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.


To protect your health and the health of all children in the community, we ask everyone about recent travel and symptoms.


Has your child traveled in the last 21 days to the following West African nations: Liberia, Sierra Leone, or Guinea?


Has your child had contact with an individual with confirmed Ebola Virus Disease?


Does your child have a fever or illness?



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