You may also download the application Admission Application form and mail to us.
Please send the completed form to:

Shriners Hospitals for Children – Los Angeles
Applications Coordinator
3160 Geneva St.
Los Angeles, CA 90020-1199

This form is a request for an initial evaluation, not for "admission" to the hospital as an inpatient. If you choose to complete the form, you do not have to fill in the space designated for a sponsoring Shriner. All requests for care are reviewed by our Chief of Staff to assure that the child has a condition that we specialize in.

If your child's condition is one that we specialize in, a packet of information will be mailed to you which includes the following:
• A letter noting the initial appointment date and time (it will include the name and telephone number of a contact person at the hospital for you to call if you have questions about your first visit)
• Several pre-registration forms
• A checklist of things to bring on your first visit
• A map and directions
• Listing of our affiliated Shrine Canters that provide transportation to the hospital

If your child has a condition that is not within our scope of expertise, you will receive a telephone call from our patient services coordinator explaining that we do not specialize in the service your child needs. If we are unable to reach you by telephone, you will receive a letter.