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Palliative Care Referral Form

Palliative care can help your patients maintain quality of life during any stage of serious illness.

This medical specialty provides essential quality of life care and an extra layer of support for patients from the time of diagnosis, during treatments, and through the end of life. Learn more.

Please scroll down to fill out our referral form to ask a question or schedule a consultation.

Palliative care differs from hospice care. Take a more in depth look at hospice versus palliative care. 

Samaritan palliative specialists help patients understand their treatment options, help them express and document their goals of care, support their decisions, and optimize their quality of life. Guided by the patient’s goals, the team aligns care and treatment plans to honor their values, wishes, and preferences – all in collaboration with other physicians and providers caring for the patient.

When to Refer a Patient to Palliative Care

  • Living with any type of serious illness.
  • Undergoing curative or life-prolonging treatments.
  • Coping with uncontrolled pain and/or symptoms.
  • Needing increased help with dressing, eating, bathing, etc.
  • Being hospitalized frequently or making multiple trips to the ER.
  • Home-bound and unable to travel to doctor’s office for issues related to serious illness.

Every patient is unique. Let Samaritan help you decide if palliative care is right for your patient.

Please fill out the palliative care referral form on this page to get started.

Person Submitting Form

Patient Information