Refer a Patient

Anyone can make a referral to Hospice of Kitsap County, and we thank you for thinking of us!

Living with a life-limiting illness can be challenging and we are here to help. A few things to keep in mind as you fill out this form. Please do not use the name of the person you think would benefit from Hospice of Kitsap County services as this is not a secure form and we want to protect their privacy. We are happy to call you or respond to your email inquiry but cannot accept this as an "official" referral until we speak to the patient and their physician.

 

Fields marked with an asterisk (*) are required.

Your Name:
*
Your Phone Number:
* (xxx-xxx-xxxx)
Email:
*
Comments:
 

If you would like more information, have questions about hospice eligibility or would rather make a referral by phone,
please call (360) 698-4611.

 

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