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Refer a Patient Patient Referral

Thank you for choosing Hospice of the Piedmont, and our affiliate Hospice of Randolph. Please fill out the referral information below and our team will contact you for confirmation. If you have not heard back from the agency within 24-hours please call 336.889.8446 and ask for our intake/referral nurse. Our team looks forward to assisting you.

Download Referral Form

Patient Referral

Please fill out the referral information below and someone should be back in touch with you by the end of the next business day to get the process started. If you have not heard back from the agency within 24 hours (or the next business day), please call 336-889-8446 and ask for our intake/referral nurse. Thank you again for your interest in our services.

If you want, you can also attach a scanned referral form.

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