Appointment Request Form

Request an Appointment

Please fill out the form below to request a medical, dental, or behavioral health appointment. A member of our team will contact you to confirm details and complete scheduling. Please note: We recommend calling our clinic directly at 713-286-6000 for the fastest response. Our team is happy to assist you by phone.
Eligibility for Services

Anyone who is experiencing any form of housing instability, crisis, or challenge that affects their access to healthcare services may receive services. You can receive services from HHH even if you have your own housing.

Insurance is not required, and you will never be charged a co-pay for services. If you do have insurance, please let us know. This does not affect your eligibility, but it helps us to provide care to more people when we can charge your insurance company.

We do not require you to have verification of homelessness or identification. We can assist you with obtaining these items if you need.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Where did you stay last night?*
Email
example@example.com
Phone Number
Please enter a valid phone number.
Preferred Method of Contact*

PhoneEmailText Message
Primary Reason for Appointment*

Medical CareMental Health CareSubstance Use / PsychiatryDental CareFollow Up VisitMedication RefillSocial ServicesVerification of DisabilityOther
Preferred Location*
Note that the Reed Family Clinic is only open to New Hope Housing or Star of Hope Cornerstone residents.
Are you an existing patient?*

YesNoI'm not sure
Anything else we should know?
Note that if you are requesting an appointment or services, we recommend calling our clinic at 713-286-6000. We do our best to respond to every inquiry in a timely manner.

By submitting your phone number you agree to receive recurring informational SMS, MMS, or Email messages from Healthcare for the Homeless - Houston. Message frequency may vary. Message & data rates may apply. Reply STOP to opt-out of further messaging. Reply HELP for more information, see our Privacy Policy.
Should be Empty:

Request an Appointment

Eligibility for Services

Note that if you are requesting an appointment or services, we recommend calling our clinic at 713-286-6000. We do our best to respond to every inquiry in a timely manner.