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Universal Home Therapy
12919 Southwest Freeway #138
Stafford, TX 77477
*This information is secured according to HIPAA standards and requirements.
Universal Dialysis, LLC is licensed by the Department of Aging and Disability, the founding company of Universal Home Therapy. We provide Home Health Care and Home Hemodialysis with a staff-assisted RN/LVN.
INTAKE REFERRAL FORM
Please complete this Intake Referral Form for your patient. Fields marked with a red asterisk(*) are mandatory & require a complete submission. When finished, click the SUBMIT button & our Intake Referral Coordinator will contact you within 24 hours.