Admissions & Referrals

Madonna Rehabilitation Hospital is pleased to provide "Madonna Mail" - message delivery to patients. Simply fill in the following form, add your message, and it will be printed off and delivered to your designated recipient. You must include the patient's first and last name for the message to be delivered.

Disclaimer:
We make every effort to maintain the confidentiality of your message, but cannot guarantee it, since the message will be printed and delivered by a staff member or volunteer. Any patient mail containing inappropriate communication will be deleted and not delivered to a patient of Madonna Rehabilitation Hospital. Madonna Rehabilitation Hospital protects patient information in accordance with HIPAA regulations and cannot guarantee or assume responsibility that patient mail has been delivered, either due to the patient's election to "opt out" of the patient registry, or the patient's departure from the hospital. Your message will usually be delivered within 24 hours of receipt, except on Saturday and Sunday, when there is no hospital mail delivery.

Your Name:
Your Email Address:
Patient's Name (First, Last):
Patient's Room # (if known):
Your Message:
Colored fields indicate required information.