Who uses this referral form?

A referring officer or agency uses it to provide information about a client being referred to the Healthy Home Program.

No notary required

Healthy Home Referral Form

This form records client and household details, recent program and police interactions, arrest information, and the issue being referred to the Healthy Home Program.

What this form is

The Healthy Home Referral Form is used to refer a client to the Harker Heights Police Department’s Healthy Home Program. It asks for the client’s contact and military-status information, household details, recent program interactions and police calls, arrest information, the presenting issue, and the referring officer’s or agency’s contact information. The form does not state when a referral is required.

Who needs it

A referring officer or agency uses this form to provide client and referral information to the Healthy Home Program.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This document is signed without a notary; the form includes a date field and identifies no notarized or sworn attachment.

How to submit this form

1
Download The Form
Download the Healthy Home Referral Form.
2
Complete The Form
Fill in the client, household, recent interaction, arrest, presenting issue, and referring officer or agency information.
3
Check For Attachments
The form text does not identify any attachments.
4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What is the Healthy Home Referral Form for?: It records client and household information, recent program interactions and police calls, arrest information, the presenting issue, and the referring officer’s or agency’s contact details.
Who uses this referral form?: A referring officer or agency uses it to provide information about a client being referred to the Healthy Home Program.
How do I submit the Healthy Home Referral Form?: The form does not provide submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
Do I need a notary for the Healthy Home Referral Form?: No. The form includes a date field and identifies no notarized or sworn attachment.

Need something notarized?

This Healthy Home Referral Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.