Refer a patient in minutes. We take it from there

Physicians, discharge planners, case managers and social workers: send a referral in under two minutes. Our intake team verifies benefits, confirms eligibility and can often admit within 24 hours.

Start a referral 24/7 referral line

The Process

A referral, made simple

No portals, no paperwork backlog. One short form or a single call starts everything.

Send the referral

Use the form below or call our 24/7 line. We only need the basics to get started. Full records can follow by secure fax.

We verify & confirm

Our intake nurse confirms hospice eligibility and verifies the patient's benefits, usually at no cost to the patient or family.

Care begins fast

Once orders are in place, care can often begin within 24 hours, with a nurse on call around the clock from day one.

Clinical Eligibility

When hospice may be appropriate

Hospice is generally appropriate when a physician certifies a prognosis of six months or less if the illness runs its usual course. Common indicators include:

These indicators are a guide, not a substitute for clinical judgment. When in doubt, call us. Our medical director is glad to talk it through, and there's no obligation.

Declining functional statusFalling PPS/KPS, increasing dependence in ADLs, or recurrent hospitalizations.
Progressive weight lossUnintentional weight loss, declining albumin, or reduced oral intake.
Advanced diseaseEnd-stage cardiac, pulmonary, renal, hepatic, neurologic disease, dementia or cancer.
Goals shifting to comfortPatient or family choosing comfort-focused care over further curative treatment.

Start a referral

A few basics is all we need to begin. Our intake nurse will follow up promptly to confirm details.

Please don't include full medical records or detailed PHI in this form. For protected health information, our intake nurse will call you, or you can fax records securely to (909) 453-0079.

Your name *

Please enter your name.

Your role

Please choose your role.

Practice / facility

Please enter your practice or facility.

Your phone *

Please enter a valid phone number.

Fax (for records)

Your email

Please enter a valid email.

Patient initials *

Please enter the patient's initials.

Patient's current location

Primary diagnosis (general)

How soon is care needed?

Anything else we should know?

Submissions are confidential. Our intake nurse will follow up to confirm clinical details securely.

Referral received. Thank you.

Our intake nurse will reach out shortly to confirm details and next steps. For anything urgent, call us any time at (909) 453-0078.