Refer a Child

MedCare accepts referrals from parents, physicians, case managers, and community agencies. To schedule an appointment or inquire about our services, simply fill out the form below and call us at 713-995-9292. Our staff will guide you through the intake process and gather the necessary referral and authorization forms.

Name

Phone

Address

Street Address

Address Line 2

City

State / Province / Region

Country

Email

Department

Insurance

Services Requested

Comment

Captcha
captcha