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. If you have any questions, please feel free to contact us.

Fast Fax Referral Form

Dying is not a happy experience, but having people surround your family and loved one as they pass meant the world to us. the fact that they actually care about dying peacefully and make it their goal to provide comfort and peace during the process was so comforting.

Rebecca Steele,