Refer a Patient - Houston Methodist J.C. Walter Jr. Transplant Center: Advanced Heart Failure

For physician use only.

If you have a patient and/or you would like to learn more about advanced heart failure therapies and treatment options, there are several ways to refer a patient to the Houston Methodist J.C. Walter Jr. Transplant Center: Advance Heart Failure Center.

EpicCare Link is the fastest and easiest way to refer a patient.
Complete the form below and a representative will contact you within two business days.
If you are a patient, please use the Houston Methodist J.C. Walter Jr. Transplant Center Patient Form instead.
This referral form is for ambulatory outpatient referral only. To send an inpatient transfer request, call the transfer center at 713.441.4848.

*denotes required field

Patient Information

Patient Full Name * Patient Address Patient City * Patient State * Patient Postal Code Patient Daytime Phone * Patient Date of Birth * Patient Insurance Provider *

Referral Information

Referral type * If Other, please specify Referral Clinic If Other, please specify

Preferred Clinic Location

Texas Medical Center 713.441.5451 | Fax 713.791.5032 Baytown 281.837.7587 | Fax 281.837.7443 The Woodlands 936.270.3933 | Fax 713.791.5134 Shreveport, LA: 318.465.3869 | Fax 318.212.8513 Sugar Land & West campus outreach clinics: 713.441.3877 | Fax 713.790.2643 (Send Epic staff message or telephone encounter to Cardio DeBakey HF Outreach)

Referring Physician * Referring Physician's Specialty Referring Physician's Practice Name * Referring Physician's Phone * Referring Physician's Email * Referring Physician's Mobile Referring Physician's Preferred Method of Contact Additional information (if any)

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Refer a Patient - Houston Methodist J.C. Walter Jr. Transplant Center: Advanced Heart Failure

Patient Information

Referral Information