TPCO Healthcare Provider Assessment

Who needs to fill out a Healthcare Provider Assessment?

  • Primary Care Physicians (MD or DO)
    • Family/General Practice
    • Internal Medicine
    • OB/GYN
    • Pediatrics

  • Psychiatrists (MD or DO)
    • Psychology
    • Clinical Psychology
    • Marriage & Family Therapist
    • Pediatric Nurse Specialist
    • Clinical Social Work

  • Dentists (DDS or DMD)
    • General Dentistry
    • Pediatric Dentistry

Note:  Please complete a separate assessment for each healthcare provider in your office.  If a provider practices at multiple locations, please fill out a separate assessment for each additional location.

For questions or further information, please visit our Frequently Asked Question (FAQ) page.


To submit a Healthcare Provider Assessment:  

Option 1:  Complete and submit an assessment online (preferred method):

Healthcare Provider Assessment – General:  

Healthcare Provider Assessment – Geographic High Needs:

Which online Provider Assessment do I complete?

If your facility is located in any of the counties listed in the table below, please use the link for the “Healthcare Provider Assessment – Geographic High Needs.”  Otherwise, please use the link for the “Healthcare Provider Assessment – General.”  

Designated/Borderline Geographic High Needs Health Professional Shortage Areas:

County Name

Angelina Concho Hardeman Maverick San Augustine
Aransas Crane Harris McCulloch San Jacinto
Atascosa Crockett Hidalgo McLennan San Saba
Bailey Crosby Hill McMullen Schleicher
Baylor Culberson Houston Menard Scurry
Bee Dallas Howard Midland Shelby
Bexar Dawson Hudspeth Milam Starr
Brazos Delta Jasper Mills Stonewall
Brewster DeWitt Jefferson Mitchell Swisher
Briscoe Dickens Jim Hogg Motley Tarrant
Brooks Dimmit Jim Wells Nacogdoches Terrell
Brown Donley Jones Navarro Terry
Burleson Duval Karnes Newton Trinity
Caldwell Eastland Kenedy Parmer Uvalde
Cameron Edwards King Pecos Val Verde
Camp El Paso Kinney Polk Waller
Cass Erath Knox Potter Ward
Castro Falls La Salle Presidio Webb
Chambers Fannin Lamb Real Wharton
Cherokee Floyd Lampasas Red River Willacy
Childress Foard Leon Reeves Yoakum
Cochran Frio Lynn Refugio Zapata
Coke Gonzales Madison Robertson Zavala
Coleman Hale Marion Runnels  
Comanche Hall Matagorda Sabine  


Option 2:  Complete and submit a fillable form via email:

Complete the Healthcare Provider Assessment fillable PDF form and click the “Submit by Email” button at the bottom of the form to submit the form directly to the Texas Primary Care email box:

Option 3:  Complete and submit by fax:

Complete the Healthcare Provider Assessment and submit the form to the TPCO by fax: (512) 776-7203.

Last updated July 3, 2019