Office: (361) 694-5678
Fax: (361) 694-4821

Fax information required by referring physician:

  • DCH patient referral form or physician’s order including physician’s signature

    • Evaluation and/or treatment specified
    • Diagnosis, including ICD-10, supporting requested services
  • Physician’s notes or H&P supporting requested services
  • Insurance / Medicaid card (front and back)

Patient must bring to appointment:

  • List of current medications
  • Patient must be accompanied by parent/guardian (with ID for verification)
  • Insurance/Medicaid card