Referral

At Home Healthcare appreciates that you have made us your choice as the home health provider for your patients, yourself or a loved one. Please complete the appropriate patient referral form either online or by downloading a copy that can be completed and submitted by fax or mail:

Secured online forms:

• Medical/Professional Referral
• Patient, Family or Friend Referral

Hard copy version:

• Medical/Professional Referral
• Patient, Family or Friend Referral

The hard copy version is a PDF file and requires Acrobat Reader, a free program available from Adobe Systems, on your computer to view and print. Download here.

Please submit the hard copy referral form by fax (903-526-2329) or via mail:

At Home Healthcare – Central Intake
9846 Hwy 31 East
Tyler, TX  75705

This information is secured according to HIPAA standards and requirements.

At Home Healthcare knows that you want the very best possible care for your patients, yourself and your loved ones. We hope that you will continue to select us as your provider of choice.