Becoming a Patient

Becoming a Patient

Thank you for your interest in becoming a patient at Texas Scottish Rite Hospital for Children in Dallas, Texas!

Criteria to Become a Patient:

How to Apply:

The Patient Referral Information Form (for pediatric orthopedics patients) or application for evaluation in the Center for Dyslexia and Learning Disorders should be completed.

Patient Referral Information Form:

Application for evaluation in the Center for Dyslexia and Learning Disorders:

Note: Your application cannot be processed without a completed and signed physician referral form.The referring physician must provide the child's name and date of birth, section A and/or section B completed in its entirety and the physician's signature, date, medical license number and demographics.

Please mail the completed form/application to the attention of Patient Access at the address listed on the application.

Need Help?:

For help with the application process, please contact Patient Access at (214) 559-7477 or (800) 421-1121, ext. 7477, or through e-mail at tsrhpa@tsrh.org.

Next Steps:

All applications are reviewed by hospital staff on a case-by-case basis when received. If the child meets the criteria listed above, and has an orthopedic condition the hospital treats or needs an evaluation for dyslexia, an appointment will be scheduled and a written notice will be sent to the parents/legally responsible persons.

Since the hospital's inception in 1921, TSRHC has treated patients regardless of the family's ability to pay. The hospital relies on the generosity of individuals, organizations, foundations and corporations to continue its mission.

TSRHC is accredited by the Joint Commission on Accreditation of Healthcare Organizations and is a member of the National Association of Children's Hospitals and Related Institutions, American Hospital Association, Texas Hospital Association and Dallas/Fort Worth Hospital Council.

Texas Scottish Rite Hospital for Children (TSRHC) does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment or participation in its programs, services and activities, or in employment. For further information about this policy, please contact:

Provider Name: Texas Scottish Rite Hospital for Children (TSRHC)
Contact Person / Section 504 Coordinator: Administrator
Telephone number: (214) 559 - 7602
TDD or State Relay number: 1-800-735-2989


Financial Assistance Program 

For information about our Financial Assistance Program, view our Charity Care Policy (English / Spanish) and our Financial Assistance Checklist (English / Spanish).

Download our Financial Assistance / Charity Care Application (English / Spanish)

For questions regarding our Financial Assistance Program, please call (214) 559-8630.