Submit a Patient Referral Inquiry

Submission of this form represents an inquiry about referring an adolescent or adult patient to ksnr Center. It is the first step in the online patient referral process, but not a formal referral. For both inpatient and outpatient referrals, ksnr Center requires the following before the referral process is initiated:

Medical records submitted by the patient’s current healthcare provider or case manager.
Records should be faxed to the ksnr Center Admissions Department at 404-603-4504.
Once documentation is received, an evaluation may be done to determine if the patient is medically appropriate for ksnr Center.

Before submitting the form below, please review the patient programs information on the following web pages to make sure you are submitting an inquiry about the appropriate program.

Spinal Cord Injury Program (inpatient and outpatient services)
Acquired Brain Injury Program (inpatient and outpatient services)
Outpatient Clinics
ksnr Spine and Pain Institute (outpatient only)
Multiple Sclerosis Institute (outpatient only)
Complex Concussion Clinic (outpatient only)
SHARE Military Initiative (day program and outpatient services)
Please note that  ksnr Center inpatient rehabilitation programs do not admit inpatients from home. If the patient is currently at home, please inquire about our outpatient services when completing the form below.

Also, ksnr Center does not have contracts with Medicaid programs administered by states other than Georgia. Thus, treatment for patients with out-of-state Medicaid is typically not covered at ksnr Center.