ONLINE PORTAL IS CURRENTLY UNAVAILABLE
Thank you for serving our families! All referrals are made with an online request form. Please remember that in order to qualify for our services, a patient’s diagnosis must be life-threatening. Since this is a restricted, HIPPA compliant form for use only by Texas Medical Center providers, we must grant individual access. Please read the instructions below on how to access our online form.
If you are a Texas Medical Center worker that wants to refer a family, you must submit a Family Referral Form online. To gain access, please submit a request by completing the access request form here. After submitting, our staff will review your request within 24 hours and you will receive an approval email from email@example.com with your username and password.
If you are a Texas Medical Center worker with access to our online referral form before, you may login here with your credentials. If you have forgotten your password, please proceed to the login page and click on “Lost Your Password?”. Enter your email and you will receive a link by email with instructions on how to reset your password. Please do guess your password more than 3 times, as you will be locked out of our site for security reasons.