Houston Methodist J.C. Walter Jr. Transplant Center Patient Form

Patients of Houston Methodist J.C. Walter Jr. Transplant Center have access to state-of-the-art resources at Houston Methodist Hospital in the Texas Medical Center. To learn more about our advanced organ failure management and transplant services, expert physicians or to seek treatment, complete the form below. A representative will contact you within two business days.

Patient First Name * Patient Middle Initial Patient Last Name * Patient Address * Patient City * Patient State * Patient Postal Code * Patient Email Address * Patient Daytime Phone * Patient Date of Birth * Transplant Center Clinic or Program * If Other Clinic or Program, please specify Insurance Provider If Other Insurance Provider, please specify Best day/time for staff to call you Monday – Friday, 8 a.m. – 4:30 p.m. Comments

Authentication *

By clicking the Submit button, you agree to the Houston Methodist Privacy Policy and Disclaimer.