Refer A Patient – Dallas Order Number Patient's Name * Hospital * Baylor University Medical Center Baylor Regional Medical Plano Baylor Irving Carrollton Regional Medical Center Children’s Medical Center Christian Care Communities & Services – Allen Christian Care Communities & Services – Mesquite Heart Hospital Plano Methodist Dallas Methodist Charlton Medical Center Parkland Hospital Presbyterian Dallas (THR) Presbyterian Plano UT Southwestern (St. Paul & Zale Lipshy) Veteran’s Affairs Hospital Lancaster Room # (if known) Patient's home church or religious preference Person Making Referral * Phone or Email * Relationship to Patient * Your Home Church Additional Information
