Make a Referral

Three easy ways to refer a patient:

• Fill in the form for the referral below and once submitted our qualified team will start the process.
• You can download the form and fax or email it us.
• You can also call in the referral, you can contact us at 323-653-0544 with following information:
  • Patient full name
  • Phone number
  • Physician name
  • Diagnosis- current H&P

If you are referring from Acute Hospital Request Victoria hospice services on your discharge orders when ordering hospice services.