Sensory Products Form ENG

Value Added Service | Sensory Products

*Valid September 1, 2026 to August 31, 2027
Dear Cook Children’s Health Plan Member,

If you are a STAR Kids Member in the IDD waiver program, ages 2 to 20, Cook Children’s Health Plan would like to send you a $25 gift card. You can use this gift card to buy a sensory product, such as a weighted blanket or noise canceling headphones.

You may request this card once you complete your annual Texas Health Steps visit.

*Date of service must be within the current state fiscal year (September 1, 2026 - August 31, 2027)
Member first name:
Member last name:
Member ID number:
Member DOB:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Parent phone number:
Format: (000) 000-0000.
Provider name (last, first):
Date of visit:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Please remember to register or log in to Healthmine to access your digital gift card and rewards.

Some limitations and restrictions may apply. Member must be active both on the date of service and on the date of request. If you have any questions please visit our website www.cookchp.org, contact us through the MyCookChildren’s Member Portal or call Member Services at 1-800-964-2247.
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