REFERRALS--Assist-Med., Inc. Home Health Care Services--Houston, Tx

Assist-Med home health offers a comprehensive list

of health care services to its clients in the

comfort of their own homes.

We have three divisions to serve you:

Licensed and certified for our Medicare clients
Licensed home health for our skilled Medicaid and Insurance clients
Personal Assistance services for our primary home care clients who need unskilled services.

Where we get our referrals:

Acute care setting
Physicians' office
Hospitals
Home

Referring someone to us is easy

Hospital representatives, physicians office and individuals can now contact us by telephone or by completing the online referral form, below. (Fax, including History and Physical with orders, to follow).

ONLINE REFERRAL FORM

Hospital

Physician's office

Individual

Sefl-referral

Location of interest

North office (Conroe area)

Central office (Houston area)

South office (Galveston area)

PATIENT'S INFORMATION

First Name:

Last Name:

Sex:

Date of birth:

Medicare ID# Medicaid ID# or Private Insurance #

Address:

Address2:

City, State, Zip:

Diagnosis (Dx):

Procedures:

PHYSICIAN INFORMATION

Name of Physician:

Address:

Address2:

City, State, Zip:

Telephone:

Fax:

Office contact:

Key in code in space below before submitting form:

Code too hard to read? Click on this blue image to refresh.

WHAT PATIENTS AND THEIR FAMILIES ARE SAYING ABOUT OUR SERVICES:

Available 24 hours a day, 7 days a week. Contact us today

North Office

(Conroe)

281-419-1464

281-419-1312 (fax)

Central Office

(Houston)

832-300-3100

832-300-3106 (fax)

South Office

(Galveston)

409-621-1114

409-621-1544 (fax)

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