Refer A Patient – Tarrant County Name Patient's Name * Hospital * Arlington Memorial Baylor Scott & White Cook’s Children Harris HEB Harris Methodist John Peter-Smith La Dora Nursing & Rehab Center Mansfield Methodist Medical City Arlington Medical City Fort Worth Medical City North Hills Wellington Oaks Nursing & Rehab Other Room # (if known) Patient's home church or religious preference Person Making Referral * Phone or Email * Relationship to Patient * Your Home Church Additional Information
