To refer a child to Shriners Children’s, use the Shriners patient referral form online at shrinerschildrens.org: healthcare providers submit the Patient Referral Form, and parents or family members use the separate Request an Appointment form on the same site. Both paths are free, and neither requires insurance or proof of income. If your child needs urgent attention, skip the online forms and call 1-800-237-5055.
Who Can Be Referred
The child must be younger than 18 when the care plan begins and have a condition within Shriners Children’s scope of treatment.1Shriners Children’s. Becoming a Patient Acceptance is based on the child’s medical needs, not on insurance, income, or where you live. Shriners Children’s operates as a 501(c)(3) nonprofit healthcare system.2Shriners Children’s. Shriners Children’s
The network treats pediatric orthopedics, burns, craniofacial conditions, spine and spinal cord conditions, rehabilitation, sports medicine, urology, wound care, and a range of neuromuscular disorders such as cerebral palsy and muscular dystrophy.3Shriners Children’s. Pediatric Care4Shriners Children’s. Congenital Neuromuscular Disorders Specific treatments vary by location, so not every facility handles every condition.
What to Gather Before You Start
Having the full picture ready prevents incomplete submissions and shortens the review. Before you open either form, collect:
- The child’s full name, date of birth, gender, and home address
- Parent or guardian name and a contact phone number
- A clear description of the child’s condition, including diagnosis, symptoms, or physical limitations
- Primary care provider name, practice, and contact details
- Insurance information if you have it (requested for administrative purposes, not required for acceptance)
- Any supporting documents: referral letter, prescription, consultation request, or related medical records
The more clinical detail you include, the faster the intake team can match your child with the right specialty department.1Shriners Children’s. Becoming a Patient Uploading a physician’s referral letter or recent imaging reports can speed up the review significantly.
For Healthcare Providers
Physicians, nurses, and other healthcare professionals submit through the Patient Referrals and Transfers page at shrinerschildrens.org.5Shriners Children’s. Patient Referrals and Transfers The online form collects the patient’s demographics, clinical history, and the referring provider’s information. Fill in every required field; the system flags incomplete submissions and will not process them.
You can also refer by phone. From the United States and all U.S. territories, call 800-237-5055. From Canada, call 800-361-7256.6Shriners Children’s. Patient Referrals and Transfers Some individual facilities also accept faxed referral packets; contact the specific location for its fax number.
The PDF version of the Patient Referral Form asks providers to check a specialty category (orthopedics, burn reconstruction and plastics, cleft lip and palate, or prosthetics and orthotics) and to include a reason for referral or diagnosis.7Shriners Hospitals for Children. Shriners Children’s Patient Referral Form Be specific. “Left tibia pseudarthrosis, considering surgical correction” tells the intake team far more than “bone problem.”
For Parents and Family Members
You do not need a doctor’s referral to start. Go directly to the Request an Appointment page at shrinerschildrens.org/en/request-an-appointment.8Shriners Children’s. Request an Appointment The form asks for patient demographics, diagnosis details, injury information if applicable, your preferred Shriners location, and parent or guardian contact details. You can upload a referral letter, prescription, or consultation request to avoid processing delays.
A few rules to keep in mind:
- Submit one form per patient. The system only recognizes one form per child, so do not file duplicates.
- Do not use the online form for emergencies. For emergency care, call 911. For urgent but non-emergency situations, call 1-855-823-7855.
- If you submitted a request within the last 14 days and want an update, do not resubmit. Instead, visit the Contact Us page on the Shriners website, select “New Patient Referral” as the inquiry type, and choose “Status Follow-Up.”
Canadian families use the same online form but will be asked for additional documentation, including a health insurance number and a copy of a healthcare card. Families in Quebec also need a copy of a prescription or referral from a care provider.8Shriners Children’s. Request an Appointment
What Happens After You Submit
Allow three to five business days for a follow-up call about your referral.9Shriners Children’s. Thank You For Referring Some locations move faster. The Chicago facility, for example, contacts families within one to two business days.10Shriners Children’s. Contact Us An intake coordinator reviews the submission to confirm the child’s condition falls within Shriners Children’s scope of care.
If the coordinator cannot reach you by phone, they will follow up by email and mail.9Shriners Children’s. Thank You For Referring Keep your phone ringer on during this window and check your spam folder. A missed call can add days to the process.
Once your child is accepted, you will receive an information packet by email or mail that typically includes:1Shriners Children’s. Becoming a Patient
- A letter with the location, date, and time of the first appointment
- The name and phone number of your assigned care manager
- Pre-registration forms to complete before the visit
- A checklist of items to bring
- A map and directions to the facility
The exact contents and delivery method vary by location. The referring physician is kept in the loop so continuity of care is maintained between your child’s local doctor and the Shriners team.
Families Outside the United States and Canada
International families can seek care, but the online form is not the whole process. An assigned international patient coordinator guides families through three stages: clinical clearance (submitting a request for care along with medical records for review), financial clearance (verifying coverage of non-medical expenses and presenting the case to the facility’s board), and travel logistics (visa, travel arrangements, and accommodations).11Shriners Children’s. International Patients Contact the international patient coordinator early, because visa processing alone can take weeks depending on the country of origin.