Patient Referral

Healthcare providers can use the Fast Fax Referral Form to send patient information to their local Agapé Hospice office. Please include Face Sheet, copy of insurance card if available, current H/P labs (within 6 months) and most recent Physician Notes with submission.

Fast Fax Referral Form

I wish to express sincere appreciation for the highly professional Hospice Care provided to my wife Elizabeth Dianne Jones. May 10 thru July 5, my dear wife of 71 years received excellent care provided by Cheryl, Dee, Jennifer, Don, Dave, and Fran. Our daughter Diana and I are grateful for the provision of personal care, supplies and the smiles and hugs provided to us. The greatest blessing of all is that my Dianne did not suffer. Her pain was managed quite well and on July 5th she with us by her side transitioned into the loving arms of our Lord Jesus at the 3:30 p.m. hour. Thank you for being there for us. God Bless You each and every one.

Curtis Jones, Jamestown, SC