Need a Room - Reba's Ranch House

THE INITIAL REFERRAL MUST BE MADE BY A SOCIAL WORKER, CASE MANAGER, NURSE, PHYSICIAN, OR HOSPITAL CHAPLAIN WHERE THE PATIENT IS BEING TREATED.
All adults, 18 and older, staying in the House must have current, valid government issued photo identification AND pass a criminal background check.
Once the initial referral has been made, Reba's Ranch House will contact the family to confirm room availability. We cannot guarantee placement until a room is available and all information has been received and processed. We operate on a first come, first serve basis. If the House is full, you will be placed on a waiting list.
Check all that apply
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- I am actively caring for a family member receiving care in a hospital in Fannin, Grayson, Bryan or Marshall Counties in Texas or Oklahoma.
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- I am able to care for myself without a caregiver or someone to help watch over me.
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- I have a valid ID.
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- I have no criminal background record.

Additional Information
Current Address:*
Street Address Address Line 2 City State ZIP Code
Previous Address (most recent):
Street Address Address Line 2 City State ZIP Code
Name of Loved One (Patient):*
Hospital of Loved One (Patient):*
AUTHORIZATION*
- TO THE BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED IN THIS NOTICE AND AUTHORIZATION AND ANY ATTACHMENTS THERETO IS TRUE AND COMPLETE.
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- I UNDERSTAND THAT ANY FALSIFICATION OR OMISSION OF MAY DISQUALIFY ME AND/OR RESULT IN MY DISCHARGE FROM REBA'S RANCH HOUSE.
Name
This field is for validation purposes and should be left unchanged.

Hope. Warmth. Home.