Make a Referral

Anyone can refer a patient for hospice care: a loved one, physician, friend, neighbor, member of the community, or even the patient themselves. Fill out the form to find out more about getting the care you or someone you know needs.

Patient First Name*
First
Patient Last Name*
Last
Date of Birth
MM slash DD slash YYYY
County
Contact Name
First
Contact Email*
Contact Phone
Patient's Doctor
Reason for Referral*

“The professionalism and genuinely kind service we received was one of a kind. My father received both the home care service and in-center service. We are all very pleased and thankful my father’s last month of life was in the caring hands of this hospice. From the staff to the volunteers, they truly made my dad’s passing less painful.”

Son of hospice patient

Quality Counts

Lower Cape Fear LifeCare ranked 92 percent in the category of “willing to recommend this hospice,” as rated by caregivers on a hospice quality survey. The national average is 84 percent.

Don’t Wait

Only 10% of our patients take advantage of the full Medicare hospice benefit which includes ALL medical care, medications, equipment and visits related to diagnosis.

To find out if you or someone you love qualifies for hospice, call 800.207.6908 or fill out the form on this page.