Referrals for Palliative Care

Are you, or someone you know, living with serious chronic illness and in need of help? Please use the below form to make a referral to Pathways and we will contact you within one business day or sooner, if possible. If you have an urgent need, please contact Pathways immediately by calling (716) 304-1214.

Any information shared will be protected in accordance with HIPAA and our Privacy Policy.  Please fill in the referral information and click Submit to send electronically.

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For questions or if you are experiencing any problems with this electronic form, please contact the Pathways Intake Department at (716) 304-1214 or

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