Parent & Other Referrals

Referral Process

- - - Complete our Referral Form below or call our Home Health office at 713-668-6690.
    - Medicaid and/or private insurance benefits will be verified.
    - Our staff will obtain a physician’s signed request for an evaluation for treatment.
    - Client’s caregiver/parent will be contacted by phone to schedule an admission visit.
    - Once the admission visit is completed, the therapist or our office staff will call to schedule the initial evaluation.
    - After the evaluation visit, the evaluating therapist will recommend the frequency of services and assist the family with scheduling appointments.
    - Services will start after the physician approves the plan of treatment and authorization is received from the insurance company or Medicaid.

Name(Required)

First Last

Email(Required)

Phone

Address(Required)

ZIP / Postal Code

Concerns/Reason for Referral(Required)

Services Requested

Physical Therapy

Occupational Therapy

Speech Therapy

Referred by

Parent

Teacher

Other

Comments

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