Eligibility - Provider Care at Home

You may have your services paid through Medicaid and the Texas Health and Human services. If you are interested in help with applying for these services please fill out this form and a staff member will contact you. You may also ring us on (512) 212 1402.

Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email

By providing a telephone number and submitting the form you are consenting to be contacted by SMS text message from Provider Care at Home. Message frequency may vary. Message & data rates may apply. Reply STOP to opt-out of further messaging. Reply HELP for more information. See our Privacy Policy www.providercareathome.com/privacy