Anyone can make a referral to any of the programs at Hickory Trail Hospital. In cases of outpatient provider involvement in treatment, intent and relationship should be established at the beginning of the admission process for optimal outcomes. The referral form below can also help ensure that an effective discharge plan is established with outpatient providers. Once completed, please fax the form to the medical records secure fax (972) 283-6204. Please note that submission of this form does not guarantee program availability, rather it assists in streamlining an admission.
Prior to admission, patients should also complete our Consent Release Form and review our What to Bring information.