Refer A Patient – Central Texas Name Patient's Name * Hospital * Arise Austin Medical Center Ascension Providence Waco Ascension Seton Cedar Park Ascension Seton Medical Center Austin Ascension Seton Hays Ascension Seton Williamson Ascension Seton Northwest Baylor Scott & White Continuing Care Temple Baylor Scott & White McLane Children’s Temple Baylor Scott & White Lakeway Baylor Scott & White Pflugerville Baylor Scott & White Temple Baylor Scott & White Hillcrest Waco Baylor Scott & White Round Rock Christopher House Austin Cornerstone Specialty Hospital Round Rock Central Texas Rehabilitation Hospital Austin Dell Children’s Medical Center Austin Dell Seton Medical Center at the University of Texas Austin Encompass Health Rehabilitation Austin Encompass Health Rehabilitation Round Rock Heart Hospital of Austin Northwest Hills Surgical Hospital Austin Olin E. Teague Veteran’s Hospital Temple Post-Acute Medical Rehabilitation Hospital Round Rock St. David’s Georgetown St. David’s Austin St. David’s North Austin St. David’s Round Rock St. David’s South Austin Texas Neuro Rehab Center Austin Westlake Medical Center Austin West Oaks Rehabilitation and Healthcare Center Austin 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
