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Intake packet - Texana Center

Intake packet - Texana Center 2026

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The document is an intake assessment application for Intellectual and Developmental Disabilities Services provided by the Texana Center. It requests detailed personal information about the applicant, including their name, social security number, date of birth, and Medicaid details. The form also seeks referral information and specifies various services available, such as assessments, service coordination, respite care, vocational training, and behavioral supports. Contact information for assistance with the application process is provided.

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Click ‘Get Form’ to open the Intake packet in the editor.
Begin by filling in your Case Number at the top of the form. This helps in tracking your application.
Enter the Applicant’s Name, Social Security Number, Date of Birth, and Age in the designated fields. Ensure accuracy for proper identification.
Provide the Address and contact information, including Telephone and Alternate Telephone numbers for communication purposes.
Indicate the Applicant's Sex by selecting either Female or Male using the checkboxes provided.
Fill in Medicaid Number and indicate if you are enrolled in Star Plus by checking Yes or No.
In the Referral Information section, complete details about who is completing the assessment and their relationship to the applicant.
Select any services you are seeking assistance with from the list provided. Make sure to check all that apply.

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2020	4.8 Satisfied (80 Votes)

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What is behavioral health intake?

During your intake appointment, a behavioral health professional will listen to your story and explore your medical history, symptoms, and therapy goals. By understanding your emotional, physical, and psychological well-being, well recommend the best treatment path for you.

Is the Texana Center closing?

In a notice to the community, Texana Center confirmed it will shut down all services under its Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) Medicaid Waiver Programs, effective Sept. 19, 2025.

Is Texana Center a non-profit organization?

Texana Center is a 501(c)3 public, not for profit, organization that provides behavioral healthcare and developmental disabilities services to residents of a six county area that includes Austin, Colorado, Fort Bend, Matagorda, Waller and Wharton Counties.

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