Physician Referrals

Referral Process

        • For referrals, please contact our Home Health office at (713) 668-6690.
        • Please provide signed orders for an evaluation for treatment.
        • Our staff will verify Medicaid and/or private insurance benefits.
        • Client’s caregiver/parent will be reached by phone to schedule an admission/intake.
        • After the admission, the evaluating therapist will schedule an initial evaluation with the family.
        • Based on the results of that evaluation, the evaluating therapist will recommend the frequency of services in a Plan of Care to be approved by the PCP.
        • The therapist and office staff will assist the family with scheduling appointments.

Download, print, and fill out the Physician Referral Form or fill out the form on this page.

You may also fax your own referral form to our Home Health office at (713) 668-6563.

Digital Referral Form: Physician Use Only

Kids Developmental Therapy
Location Selection for Kids Developmental Clinic
Home Health Therapy Requested(Required)
Evaluation and Treatment Requested(Required)
*Select all that apply. Please note, plan of care and evaluation to follow.

Physician Information

Physician's Address(Required)

Patient Information

Diagnosis & Referral Information

Typing your name here serves as an electronic signature.
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