Refer or request care

Refer a wound patient to Gateway.

For facilities, discharge planners, home health agencies, physicians, social workers, and care teams that need a clearer wound-care next step.

Referral Form Request Care

GatewayWound Care

Referral desk

Request care or refer a patient.

Share where the patient is, what kind of wound it is, and who is coordinating care. Gateway routes the next step across homes, facilities, and referral partners.

1Home, facility, or discharge setting

2Wound type and what changed

3Best contact person

Greater St. Louis focus Missouri county coverage Mobile + facility pathways

Request Care Refer a Patient

Refer a Patient

Send the practical referral details.

This is for referral sources. Families and patients can use the Request Care form instead.

Organization * Your name / title * Best phone * Email Patient first name or initials Patient setting * Facility / city * Wound type * Urgency * Best next contact *

Brief referral note I understand detailed clinical records should move by secure fax or another appropriate channel.

What to share first

The minimum useful information.

Keep it simple. The goal is to understand where the patient is, what the wound is doing, and who can answer questions quickly.

Patient location

Home, facility, hospital discharge, physician office, city, zip, or facility name.

Wound concern

Diabetic foot ulcer, pressure injury, venous ulcer, surgical wound, wound VAC, graft site, skin tear, or other wound.

Care team

Primary care, surgeon, podiatry, vascular, home health, facility nurse, case manager, or family contact.

Urgency

What changed, what failed, what is worrying the caregiver, and whether emergency care is needed.

Public form notice

Use this form to start the conversation. Do not send Social Security numbers, photographs, full medical records, insurance cards, or detailed clinical documents through this public form. Gateway will follow up and move clinical information through the proper secure channel. Fax is available at 314-786-7966. If this is a medical emergency, call 911.