Patient Referral Form

Anyone can request hospice services for hospice care. In fact, some patients refer themselves. We will contact the patient’s physician/caregiver to ensure that hospice care is the best choice. Once it has been decided to consider our care, the patient and family are asked to meet with a A-1 Hospice Care, Inc. staff member to determine what the patient’s and family’s needs are and explain what services we can provide.
For a quick verbal referral please call us: (888) 650-1616

The initial visit can be completed at the patient’s home, in the hospital, assisted living facility, long-term care facility, or wherever the patient and family feel it is most convenient. On admission, the patient and family are asked to sign various forms to enter into the program. These forms are required by government or accrediting organizations, and will be explained to you. The A-1 Hospice Care, Inc. team develops a plan of care that meets each patient’s individual needs.

Because we value your time, the following inquiry form is designed to offer a quick and convenient way to initiate the referral process. If you would prefer to speak directly with one of our specialists, please use the contact form instead to get in touch with us.

We provide support to you and your loved ones during an advanced illness.