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Make a Referral

Do you know someone who could benefit from a health promotion class? Whether you are a friend, a relative, or a health professional, it’s easy to make a referral. When you refer someone to one of Texas Healthy at Home’s classes, they will be contacted by a representative in their area. The representative will help them find a class that best fits their needs.

Please fill out the form completely. For more information about Texas Healthy at Home classes, please email us at


Information of Person Being Referred

Referrer Information

Doctor and Patient
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