Patient Referral Form

Sending a referral is quick, easy, HIPAA compliant, and secure! You can send us your referral by any of the submission methods listed below:

• Online by filling out the form below
• Fax your patient's Rx, Progress Notes and Face sheet to 210 340-2182
• Phone - call us at (800)-726-1966, 9:00am - 5:00pm

Referrals received before Noon Central Standard Time will be processed the same business day. Referrals received after 12pm Central Standard Time will be processed within 24 business hours. Once you referral is received, our intake coordinator will contact your patient to begin the intake process and coordinate an in-home evaluation if needed.

Referral Form