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Referrals to our Bethell Hospice Residence Care Program can be made either by the individual seeking service or by a medical services provider.
PLEASE NOTE, the online forms are currently not working. If you wish to submit a Residence Referral Form, or Residence Admission Agreement Form, please contact Amita Patel or Dorothy Rankin, Intake Coordinators at 905-838-3534, ext. 2240, or firstname.lastname@example.org
Messages sent via the internet can be intercepted. If you are concerned about providing your personal information by email or website form submission, please contact us directly at 905-838-3534 to arrange for an alternate method of communication.
For more information, please refer to our Bethell Hospice Privacy Statement.
Once your Residential Referral Form has been accepted, the Residential Admission Agreement will also need to be completed.
For more information or if you need assistance in completing a form, please contact:
Amita Patel or Dorothy Rankin, Intake Coordinators at 905-838-3534, ext. 2240 or email@example.com