TAMPA GENERAL HOSPITAL REHABILITATION CENTER
REHAB PATIENT REFERRAL
Would you like to refer a patient? Please complete the form below and fax to the
appropriate department. We will contact you within two business days.
Patient Name
Diagnosis or
Description of
Condition
Program Patient is Being Referred To?
 Inpatient Acute Rehab
 Outpatient Therapy
Pain and Headache Program
Referred By
 Outpatient Chronic
E-Mail Address
Phone Number
Fax Referrals, as appropriate, to:
TGH Rehab Inpatient Acute Program Admissions Office:
813-844-1477
TGH Rehab Outpatient Programs Admissions Office:
813-844-1948
TGH Rehab Outpatient Chronic Pain and Headache Admissions Office: 813-844-7751
For Questions, Please Call:
TGH Rehab Inpatient Acute Program Admissions Office:
TGH Rehab Outpatient Programs Admissions Office:
___________________________________________________
P.O. Box 1289 . Tampa, Florida 33601-1289 . (813) 844-7700
Affiliated with the USF College of Medicine
813-844-4172
813-844-7719
TGH Rehab Outpatient Chronic Pain and Headache Admissions Office: 813-844-7900
___________________________________________________
P.O. Box 1289 . Tampa, Florida 33601-1289 . (813) 844-7700
Affiliated with the USF College of Medicine