Refer a Patient or Family Member to VITAS today.

Thank you for your referral to VITAS Healthcare. Complete the form below to submit your secure referral.

How it works:

1. Complete the form

Enter the patient’s name, then provide your name and contact information.

2. Expect a phone call

We will contact you with an update in approximately 30 minutes. We will contact the patient or caregiver to schedule a visit.

3. Eligibility

Our team of professionals will determine if the patient is eligible for our hospice services.

Relationship to patient:

Please select to start the form.

If you would like to speak to us in person, call to make a referral over the phone.

844.535.9252

Download the VITAS App for an instant and secure submission of your patient’s face-sheet.

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*Patient's First Name:

*Patient's Last Name:

Facility Name :

Facility State:

Facility City:

*ZIP Code:

*Referrer's First Name:

*Referrer's Last Name:

*Referrer's Phone Number:

*Referrer’s Email Address:

*Your First Name:

*Your Last Name:

*Your Email Address:

*Your Phone Number:

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Thank you for your referral to VITAS Healthcare.

Our admissions professionals will contact the patient or caregiver to schedule a visit and dispatch a VITAS team member to the bedside. We will contact you with an update in approximately 30 minutes.

If you have immediate concerns, please contact us at 844-535-9592 and reference your confirmation number below.

Confirmation #:

How it works:

1. Complete the form

Enter the patient’s name, then provide your name and contact information.

2. Expect a phone call

We will contact you with an update in approximately 30 minutes. We will contact the patient or caregiver to schedule a visit.

3. Eligibility

Our team of professionals will determine if the patient is eligible for our hospice services.

Something went wrong with your submission

Please try again, or you can call us at 844.535.9252.

RESTART THE FORM

How it works:

1. Complete the form

Enter the patient’s name, then provide your name and contact information.

2. Expect a phone call

We will contact you with an update in approximately 30 minutes. We will contact the patient or caregiver to schedule a visit.

3. Eligibility

Our team of professionals will determine if the patient is eligible for our hospice services.

Refer a Patient or Family Member to VITAS today.

How it works:

1. Complete the form

2. Expect a phone call

3. Eligibility

Thank you for your referral to VITAS Healthcare.

How it works:

1. Complete the form

2. Expect a phone call

3. Eligibility

Something went wrong with your submission

How it works:

1. Complete the form

2. Expect a phone call

3. Eligibility

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