Public form purpose
The patient/family and professional referral forms collect basic contact, location, setting, care-need, urgency, and routing information so the care team can determine the appropriate next step.
Do not submit detailed protected health information
Do not paste or upload full medical records, wound photographs, Social Security numbers, insurance cards, or other detailed protected health information through the public website. Call the intake team for the appropriate secure channel.
Routing
Metro East Health submissions go to the Gateway Wound Care team at [email protected]. Form delivery uses FormSubmit unless the deployment is later connected to a different secure backend.
Emergency limitation
This website is not monitored as an emergency service. Call 911 for urgent or life-threatening symptoms.
Contact
Questions about website privacy can be directed to [email protected] or 314-325-0126.