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Community Program Forms

Community Referral Form

Once your Community Program Referral Form has been accepted, both the Consent Service Agreement for the Community Program and the Bethell Hospice Foundation Form will need to be to be completed. See below.

Please Note:  Attempts are made to process new referrals within 5 business days; however, there may be delays on occasion. We appreciate your patience during these times.

CONSENT SERVICE AGREEMENT Community Program

Form 1 of 2. Please also complete the next form, Resident/Community Client Consent for Bethell Hospice Foundation below.

RESIDENT/COMMUNITY CLIENT CONSENT for Bethell Hospice Foundation

Form 2 of 2.

Parental Consent Form

Please complete this form for all minors under the age of 18.

Consent Form for Complementary Therapy Services

For more information, or should you require assistance in completing a form, please contact a member of our Supportive Care team by email at communityintake@bethellhospice.org. Thank you.

email consent & use Form

Please complete this form to allow us to permit communications to you via email.