Referral Form

Admission Referral / Request for Evaluation

Thank you for your interest in Madonna Rehabilitation Hospital. To make an online referral request, please fill out the following form. A representative from our Admissions department will contact you for specific patient information.

Referral Contact Information
City, State, Zip Code
Patient Information
Madonna Rehabilitation Hospital
5401 South St.
Lincoln, NE 68506
Phone: (402) 413-3000
Toll-Free: (800) 676-5448