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Referrals

   

 

Assist-Med home health offers a comprehensive list

of health care services to its clients in the

comfort of their own homes.

 

 

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

  Self-referral


Location of interest

  Head office ( Dairy Ashford)

  North office (Conroe area)

  East office (Beaumont area)

  South office (Galveston area)


PATIENT'S INFORMATION

First Name:

Last Name:

Sex:

Date of birth:

Medicaid ID# or Private Insurance #

Address:

Address2:

City, State, Zip:

 


 

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

OUR HEAD OFFICE

2000 S. Dairy Ashford Rd, suite 450, Houston, Tx 77077

Tel: 832 300-3100   Fax 832 300-3106

North Office

(Conroe)

281-419-1464

281-419-1312 (fax)

East Office

(Beaumont)

409 356-9055

409 347-7890 (fax)

South Office

(Galveston)

409-621-1114

409-621-1544 (fax)

 

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