Your patients' comfort is our primary concern. In addition to complementing the physical care you offer, we help your patients and their families cope with the many spiritual and emotional dimensions of living with a serious illness.

We promise to work cooperatively with other health care providers for our patients' greater good.

Referring patients with a life-limiting illness to our care will help them live in comfort and dignity, even when cure is no longer possible. Early referral to Avow Hospice will give them pain management and symptom control, psychological/spiritual support and peace of mind. Avow Hospice also helps your patients' families and friends cope with issues of grief and loss.

We accept patient admissions 24 hours a day, seven (7) days a week.

To make a referral, call us at (239) 261-4404 or print and fax our Physician Referral Form. Our fax number for referrals is (239) 430-1011.

Please have the following information ready for the patient you're referring:

• Name
• Address
• Phone number
• Date of birth
• Social Security number
• Medicare number/insurance plan number, if applicable
• Diagnosis for hospice care
• Treatment plan (i.e., chemotherapy, radiation)
• Schedule of any diagnostic tests (i.e., blood work, x-rays, CT scans)
• Date of last physician visit
• Name of caregiver
• Phone number of caregiver

Per regulations, we must also obtain the following:

• History and physical or discharge summary
• Recent office notes (within the last six months)
• Pertinent labs or diagnostic test results

Our Admissions Department will contact your patient and his or her family members upon referral.

	2008 Physicians Referral Form (size: 372 KB)