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Request Home Health Services

Complete the form below to start the referral process. Our team will contact you within 1-2 business days.

Veteran Information

Home Address

VA Information

Your information is secure and will only be used to coordinate your care.

What Happens Next?

  • Our team reviews your referral within 1-2 business days
  • We help coordinate with the VA if you need a referral
  • Once authorized, we schedule your first home visit
  • Care begins in the comfort of your home

Prefer to Call?

Our bilingual team is ready to assist you with the referral process over the phone.

956-556-5596

Important Tip

When VA Community Care calls you to confirm your home health provider, make sure to say: "I want United Home Renal Care."