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Treasure-Services-logo

Licensed HCSSA

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~300 Attendants — Staff Quickly

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24-Hour Response

Why Refer to Treasure Services?

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All Major TX Medicaid MCOs

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EVV Compliant

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EVV Compliant

Referral Options

Option D: Quick Referral

Already have a referral form from your organization? Upload it here.

Patient Insurance
Urgency
Download our referral form, fill it out, and fax it to us.
Option B: PDF Download
📄 Download Referral Form (PDF)
Fax to: (409) 853-1791
Option C: Complete Online Form
Submit comprehensive referral information online. We respond within 24 hours.
Fill Out Complete Form ↓
Fax to: (409) 853-1791

Option D: Upload Your Form

Already have a referral form from your organization? Upload it here.

Complete Patient Referral Form

Referring Professional

Patient Information

Service Details
Service Details

Other Ways to Refer

Phone:

(409) 853-1371

Fax: 

(409) 853-1791

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