HCS/TxHmL Transfer Inquiry Form
This is an informational form for Imagine Art to collect data on your needs for waiver services.
This is not a request for transfer form. Imagine Art staff will contact you regarding initiating a transfer if determined a match.
Email address *
Contact Information *
Please include your name and phone number.
Your answer
Relation/Role *
Required
General Location of Client/Services (Zip Code or North, South, East, West Austin) *
Your answer
Are you looking to transfer to another provider? *
Please note: If you are not looking for Imagine Art to manage your waiver services, but are interested in attending our dayhab as an artist or volunteering, please fill out our Artist Application or Volunteer Application on our website.
Waiver Type *
Please note: Imagine Art only provides the HCS and TxHmL waivers at this time.
Service Details *
Please indicate which services you will need provider/agency support with.
Required
Additional Information
Please include any other pertinent information - i.e. staff, schedule, location of services, etc.
Your answer
Imagine Art Policies *
Imagine Art requires a transfer effective date 30 days from the date of the transfer meeting. Imagine Art does not currently operate a Group Home - All group home inquiries will be put on our Waiver Waiting List. Clients are always encouraged to pursue another provider that can provide the services they need in a timely manner.
Required
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