Eligibility and Application
Children up to the age of 18 are eligible for care at Shriners Hospitals for Children® if, in the opinion of our physicians, there is a reasonable possibility they can benefit from the specialized services available. Acceptance is based solely on a child’s medical needs.
Application Procedures for Orthopaedic Care, Spinal Cord Rehabilitation, Cleft Lip and Palate Repair and Non-Emergency Burn Care
The service area of Shriners Hospitals for Children® includes the United States (including Puerto Rico), Canada, the Republic of Panama and Mexico. As of April 2009, we are temporarily not accepting new patients residing outside of these areas.
Download an application for treatment:
Application for Treatment and Application Help (pdf) (English)
Application for Treatment and Application Help (pdf) (Spanish)
Application for Treatment and Application Help (pdf) (Russian)
Application for Treatment and Application Help (pdf) (French)
Canadian hospital only French or English
Forms can also be obtained from any Shriner or Shrine Club; by writing to Shriners Hospitals for Children®, P.O. Box 31356, Tampa, FL 33631; or by calling (800) 237-5055. (In Canada, call (800) 361-7256.) Completed applications should be returned to the nearest Shriners Hospital for Children®.
Notice of Privacy Practices:
English
Spanish
Russian
French
For information about a completed application or for other questions, please e-mail patientreferrals@shrinenet.org, or call (800) 237-5055 or (800) 361-7256 in Canada. Both lines are staffed weekdays between 8 a.m. and 5 p.m. EST.
Application Procedures for Emergency Burn Care
The sooner a child with burn injuries reaches a Shriners Hospitals for Children® that specializes in burn treatment, the better the chances of recovery.
In an emergency, the referring physician treating a child with burn injuries should telephone the chief of staff at the Shriners Hospitals for Children® in Boston, Cincinnati, Galveston or Sacramento and indicate that there is a patient needing emergency burn care.
The telephone numbers for emergency admissions to Shriners Hospitals for Children® specializing in burn treatment are:
- Boston: (800) 255-1916
- Cincinnati: (866) 947-7840
- Galveston: (409) 770-6773
- Sacramento: (916) 453-2111