REFERRAL FORM

Anyone can contact us about someone who may benefit from our hospice services. If you would like to make a referral, please keep in mind that in order for a patient to be eligible, these criteria must be met:

• Be diagnosed with a terminal illness and reduced life expectancy if the illness runs it normal course.

• Desire comfort measures, rather than curative treatment.

• Be located in one of our service areas

If you feel Shoals Hospice can serve your loved one, please call or fill out the referral form below: