Hidden Roots Mental Health- Texas Referral Form
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Email *
Intake Name:  *
Date: *
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Address:
Phone Number: *
Insurance Provider : 
We currently accept the following Medicaid plans:

- Aetna Better Health of Texas Inc.
- Texas Children's Health Plan 
- Molina Healthcare of Texas, Inc.
- Superior HealthPlan
- TMHP

*If your current plan is not listed and you're interested in changing plans, please enter your current insurance provider below and we will contact you to assist with the process.

 *
Referral Source: *if applicable 
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