Child Intake

Intake Paperwork

You will need to print and fill out this first portion of the intake paperwork. It should be completed and brought with you when you come to the office for intake.

The following intake paperwork is for your personal records. You can download and save it or ask for a copy when you come into the office for intake.

Financial Information

Disclosure: The mental health services we offer are funded by the State of Texas, local government, and consumers who have the ability to pay. We will not deny you services just because you cannot pay for them. Our charge for services is based on your ability to pay. The way we determine your ability to pay is fair, and is the same for everyone. We will show you how we determine the charges and answer any questions you might have.


Financial information is required and payor sources will be utilized for qualifying services.  Insurance cards, Medicaid cards, and Reward Letters are to be provided during the intake process.

Please provide your insurance information upon arrival.

However, Texoma Community Center does provide services to individuals who meet qualifying requirements regardless of ability to pay.