Forms

Click on any of the forms below to view, print, complete, and fax/mail

• 

  TXPHP Self-Report Form

• 

  TXPHP Primary Care Provider Report Form

• 

  TXPHP Mental Health Counselor Report Form

• 

  TXPHP Psychiatry - Mental Health Provider Report Form

• 

  TXPHP Recovery Monitor Quarterly Report Form

• 

  TXPHP Work Site Monitor Form

• 

  TXPHP County Medical Society/TOMA PHR Committee Quarterly Report Form

• 

  Compliance Report Request

• 

  Consent for Records to TXPHP

• 

  Practice and Prescribing Restrictions Report