Make a Referral

Referrals can be faxed, emailed, or called in to the Origami Admissions Team. Please send or be prepared to answer questions regarding

  • The individual’s current location and contact information
  • Potential date of admission
  • The individual’s date of injury
  • The individual’s level of injury
  • Current medical records or pertinent medical history
  • The individual’s contact person (i.e., case manager, family member, guardian, discharge planner)
  • Insurance information (include claim number, policy number, and customer service number)
  • We will also need physician orders for the recommended service


Not sure which program is appropriate?  Click here to see our Admission Criteria-at-a-glance.

Online Referral Form
Person/Provider Making the Referral
Primary Diagnosis
Type of Insurance