Referrals for Hospice Care

Do you know someone who might be appropriate for hospice care? Please use the below form to make a referral and we will contact you within one business day or sooner, if possible. If you have an urgent need, please contact us immediately by calling (716) 439-4417.

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

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For immediate assistance, questions or if you are experiencing any problems with this electronic form, please contact the Niagara Hospice Intake Department at (716) 439-4417 or send an e-mail to

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