Your role as
a referring professional.

Working together to ensure the best possible care.

Health care professionals, particularly primary care physicians, play an invaluable role in helping patients at the end of life. Often, you are in a position to recognize and provide a recommendation for hospice care. Once the decision to refer is made, a family physician often continues to be the patient’s primary attending physician. In addition, our Board Certified Hospice Care physicians will also provide oversight on all patients, ensuring the highest level of care.

Timely referrals are beneficial to both patient and hospice. Deciding early on that hospice is appropriate allows sufficient time for families to better adjust emotionally, as well as for the care team to form the type of therapeutic relationship that truly makes a difference.

Faith Presbyterian Hospice is the primary faith-based, nonprofit provider of hospice service in the Dallas metroplex, delivering an unequaled range of services and programming. Our experienced, dedicated team gives patients and families precisely what they need during these final chapters of a loved one’s life. To refer a patient in your care, please take these steps:

Complete and submit the e-referral form (all fields are required). By submitting this information, you verify that you are the patient’s physician. All information transmitted is private and secure.

Order for Hospice | Physician Referral

Referrer's Last Name*
Referrer's First Name*
Referrer's Title*
Referrer's Phone Number*
Referrer's Email Address*
Patient
Last Name*
First Name*
Middle Name*
Current Location*
Attending Physician
Last Name*
First Name*
Attending Physician's Hospital and/or Organization*
Office Phone*
Office Fax*
Primary Caregiver / Point of Contact
Last Name*
First Name*
Phone*
Relationship to Patient*
Is the patient/primary caregiver aware of the diagnosis/prognosis?*
Is the patient/primary caregiver aware of the referral to Hospice?*
Do we have permission to reach out to the primary caregiver/point of contact?*
*Denotes required field.
Name
This field is for validation purposes and should be left unchanged.

Navigating life’s final passage is never easy. At Faith Presbyterian Hospice, we are dedicated to providing exceptional, faith-based care to those with a life-limiting illness or injury. As a nonprofit, our bottom line is the quality of service and depth of compassion we provide your patients and their families. Thank for you choosing Faith Presbyterian Hospice. We appreciate your confidence by enabling families and patients to make Each Moment Matter. Please contact our office at 972-239-5300 if you need to speak to one of our Referral Intake Coordinators.

Fax recent history, physical and medical records pertaining to diagnosis, and patient demographic information to Faith Presbyterian Hospice at 214-413-1555.

Your role asa referring professional.

Working together to ensure the best possible care.

Order for Hospice | Physician Referral

Patient

Attending Physician

Primary Caregiver / Point of Contact

Important Links

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Your role as
a referring professional.