The following documentation is required for  scheduling an Outpatient Substance Use Treatment program screening appointment. 

Please submit all of the required information below. 

Instructions:

1. Photos of documents are to be taken in well-lit areas so that all information can be seen. 
2. Document should fill the whole viewing area.
3. Take photos on a flat surface. DO NOT hold the card in your hand.  

NOTE: ALL working adults, living in the household, are required to provide proof of income.

It is possible that the State of Texas will cover the all program cost for the individual seeking treatment. 

Indivudals who are unemployed are to provide a letter  stating that you are unemployeed. 

Any of the following are acceptable document for Proof of Income. 

1. Paystub
2. Statement (letter) from employer or the person paying your bills.
   1. Letter or Statement must include the following:
      • Full Name and phone number of individual or Company
      • Name of individual seeking service
      • Dollar Amount given for work being done
      • Date and signature of both individuals
3. Income Tax Return
4. Disability/SS Benefits Page
5. VA Benefits 

Bank statements not accepted.

Any one of the following are acceptable document for Proof of Residency:

1. TEXAS Driver's License/ID Card
2. Utility Bill
3. Letter/Statement from employer/Letter from the person paying your bills:
   1. L etter or Statement  must  include the following:
      • Full Name and phone number of individual writing the letter 
      • Name of individual seeking service
      • Residence Address with correponding Utility Bill
      • Date and signature of both individuals

VA Insurance Card included.