AAACT CLIENT INTAKE AND
SERVICE REQUEST ONLINE FORM
(Bell, Coryell, Hamilton, Lampasas, Milam, Mills & San Saba counties only)
The information on this form is required by your local service provider, the Area Agency on Aging of Central Texas and the Texas Department of Aging and Disability Services. All information provided will be kept confidential and guarded against unofficial use. Information gathered through an intake or through an assessment may be shared to effectively plan, arrange and deliver services
to meet individual client needs.
AAACT staff is not authorized to contact the client unless a Release of Information is on file with the referring agency. All others, AAACT staff will call the contact person first.