Texas Health and Human Services (HHS) maintains DBMD Documentation of Provider Choice Forms for applicants, individuals or legally authorized representatives (LARs) to use when choosing a DBMD provider agency. The forms are maintained for each HHS region and are updated monthly, or as needed. Please select from the links below to access and print a choice list.

Note: The documents below are designed to be printed and completed by hand. If you use assistive technology and have trouble accessing these forms, please contact the staff person below. If you are a DBMD provider and notice an error, please contact the staff person below via email to request a change.

Contact for Provider Choice Forms

Email dbmdpolicy@hhsc.state.tx.us.

Download a Provider Choice Form

If you don’t know in which HHS region you reside, click here for a list of regions and the counties located within.