Patient Referral

Anyone can refer someone to hospice. Fill out the form below by choosing how you want to be contacted. We will be in contact shortly.

Name
Preferred Method of Contact

Patient Information

FIRST NAME
Name

Patient Information

Max. file size: 256 MB.
MM slash DD slash YYYY

Disease Process (Check all that apply)

Challenging Behaviors (Check all that apply)

Functional Status (Check all that apply)

Other Conditions (Check all that apply)

Cardinal Hospice Michigan Service Areas

BAY CITY HOSPICE

OXFORD HOSPICE

OFFICE HOURS

Monday – Friday 8:30 – 5:00

HOSPICE TEAM

  • Registered Nurses

  • Medical Directors

  • Certified Hospice Aids

  • Social Workers

  • Chaplains

  • Volunteers

  • Bereavement Counselors

  • Therapy Services

  • Dietitian