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.

Relationship to patient:

Please select to start the form.

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

*Patient's First Name:

*Patient's Last Name:

*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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Any Questions?

If you are a clinician who prefers to speak to us in person, call 844.535.9252 to make a referral over the phone.

VITAS has streamlined the hospice referral process with a mobile application for iPhone, iPad, and Android users.