Make an Acute Inpatient Rehabilitation Referral

If there is an individual who would benefit from the inpatient rehabilitation services we offer at Mercy Medical Center, please complete the form below. An admission coordinator will contact you shortly.

In order to assess patient needs and eligibility, you will need to provide additional information, including:

  • Demographic sheet
  • PT/OT/ST evaluation and treatments
  • Recent vital signs
  • Laboratory values and radiology reports
  • History and physical
  • Physician progress notes
  • MAR

Mercy’s admission coordinator will work with you to obtain this information. If you have any questions, please call 330-580-4716 or 330-580-4717.