Referrals | Reinhart Guest House

Refer a Family

COVID-19 Update: We are focused on limiting the spread of COVID-19, therefore the Guest House will frequently evaluate occupancy and may limit the number of available rooms.

Instructions:
The form must be completed by a provider or other healthcare personnel at St. Mary’s Hospital or affiliate via this online form.

Notes:
Please advise the guest that their reservation is tentative until guest house staff contact them regarding availability.

Eligibility guidelines are established to clearly identify who can stay as guests at the Evelyn D. Reinhart Guest House. The guidelines will be applied without prejudice or favor.

In order to determine the guests’ eligibility to stay at the Reinhart Guest House, the following guidelines will be followed:

Guests must live at least 30 miles from St. Mary’s Hospital.
Guests are encouraged to pay the suggested room rate of $50 per night towards their stay; however, no one is ever turned away due to their inability to contribute.
Guests must be referred by a provider or other healthcare personnel at St. Mary’s Hospital or affiliate via the online referral form.
When assessing referrals, we are following the current hospital visitor guidelines.

If exceptions to our guidelines need to be considered, please call the Guest House at 804-287-7300.

Incomplete forms will be returned for completion.

Photo ID is required for admission.

Referral Information

To be completed by the professional submitting the form.

First Name *

Last Name *

Title *

Phone *

Email *

Pager

Fax

Treating Physician *

Room/Unit

Appointment dates and times

Guest Information

Please provide information on the guests requesting a room at the Reinhart Guest House.

Guest First Name *

Guest Last Name *

Relationship to patient *

Guest Address *

Guest City *

State / Province / Region *

Guest Postal / Zip Code *

Country *

Guest Email

Guest Cell Phone Number

Guest Home Phone Number

Expected Date of Arrival

Expected Date of Checkout