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480.321.8455  · 24/7

Refer a patient

Send us what you have. We call you back the same day.

Three ways to send a referral

Use whichever is fastest for you. All three reach the same intake team, and the phone is answered around the clock.

Phone, answered 24/7
480.321.8455
Fax
480-405-6370
Email
info@covenanthospicecares.com

Please do not send patient details by email unless your system encrypts outbound mail. The form and the fax line are the safer routes.

Referral form

Seven short steps. You can move back and forward, and the only fields we hold you to are the ones we cannot start without.

Step 1 of 7

Who is referring

Takes about a minute. We only need a way to reach you back.

Fields marked * are required. Everything else is optional, so send what you have and we will call you for the rest. If this is urgent, call 480.321.8455 and we will take it over the phone.

Step 2 of 7

About the patient

If you do not have something, leave it blank and we will get it.

Step 3 of 7

Clinical snapshot

Enough for our team to size up the referral. Not a full chart.

Step 4 of 7

What is changing

Check whatever applies. The last question matters most to our team.

Step 5 of 7

Goals of care

Where the family is in the conversation, as best you know.

Step 6 of 7

Physician and coverage

We verify coverage before care begins, so an estimate here is fine.

Step 7 of 7

Records and timing

Last step. Tell us how fast you need us.

What happens after you send it

  1. We call you back

    Within the hour during business hours, and the same day otherwise. If you marked it STAT, we call before anything else.

  2. We verify coverage

    We check the benefit before care begins. Most families pay nothing out of pocket, and we tell the family what to expect rather than letting a bill explain it later.

  3. A nurse comes out

    At the hospital, the facility, or the house. We work around the discharge, not the other way round.

Nothing posted that fits you?

Call anyway. We would rather know a good clinician exists before we need one.

480.321.8455
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