Bexar County Forms

2. 
4. First Name*
5. Last Name*
7. Email*
9. Update Type*

   1. New Entry
   2. Update Entry
   3. Delete Entry
11. Submission Criteria & Accessibility

    All directory submissions will be monitored and reviewed by department staff to ensure that agencies align with department values and Bexar County requirements. Final directory inclusion is not guaranteed. 

    To be considered, agencies are required to provide one or more services to the Safety Net population (defined as unfunded and underfunded individuals). Agencies must accept individuals on one or more of the following: Medicaid, sliding scale, or unfunded/scholarship basis. 

    1. My agency accepts individuals with Medicaid, sliding scale, or unfunded/scholarship basis.
15. Agency Information
19. Agency Name*
21. Agency Address(es)
23. Phone Number
24. Website
26. Upload Program Brochure
30. Service Categories

34. Use this section to indicate services that you offer independently. If the general public cannot come to your agency solely for one category, then do not select items in that category. For example, do not select mental health services if they are dependent on participating in a substance use treatment program. These sections are broken down for the end-user and we want them to find your services in the correct sections of the directory. Feel free to fill in the "Other Services Provided" section to ensure we capture the full spectrum of your services. 

36. Mental Health Services

    1. Inpatient Hospitalization
    2. Individual Therapy
    3. Group Therapy
    4. Case Management
    5. Medication Management
    6. Partial Hospitalization Program
    7. Intensive Outpatient Program
    8. Crisis
37. Substance Use Services

    1. Residential
    2. Intensive Outpatient
    3. Partial Hospitalization
    4. Peer/Recovery Support Services
    5. Detox
    6. Medication Assisted Treatment
38. Telehealth Services

    1. Yes
    2. No
40. Social Services

    1. Clothing Assistance
    2. Dental Assistance
    3. Financial Assistance
    4. Eyeglasses/Optical Assistance
    5. Food/Grocery Assistance
    6. Laundry Facilities
    7. Legal Assistance
    8. Transportation
    9. Utility Assistance
41. Housing

    1. Emergency Shelter (Children)
    2. Emergency Shelter (Women)
    3. Housing & Assistance
    4. Temporary & Transitional Housing
42. Specialized Services

    1. Deaf & Hard of Hearing
    2. Domestic Violence
    3. First Responders
    4. HIV/AIDs Care
    5. Intellectual & Develop. Disabilities
    6. Pregnancy
    7. Veteran Services
44. Other Services Provided
48. Program Details
52. Population Served

    1. Adult
    2. Geriatric/Senior
    3. Child & Adolescent
53. Capacity
57. Funding
61. Funding Options

    1. Private Insurance
    2. Medicaid
    3. Medicare
    4. Tricare
    5. Sliding Scale
    6. Private Pay
    7. Unfunded
62. Other Funding Options
66. Staffing
70. Number of Employees
72. Credentials

    1. LPC
    2. LPC-A
    3. LMSW
    4. LCSW
    5. LMFT
    6. LCDC
    7. RN

    1. LVN
    2. RN
    3. PA/NP
    4. Psychologist
    5. Psychiatrist
    6. Recovery/Peer Specialist
74. Other Credentials
78. Additional Information
82. Additional Details
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

* indicates a required field