Referral Form Make a Referral
Thank you for choosing Hospice of the Piedmont, and our affiliate Hospice of Randolph. To make a referral, complete the form below or download a referral form and return by fax.Download Fax Referral Form
Upon completion of this form, a member of our Admissions and Referral team will be in contact with you. If you have not received a call back within 24 hours (or the next business day), please call 336-889-8446.
Your entire team was amazing. They are very professional in their work but also have big hearts and it comes through in how they do their work and in their positive attitudes.
Thank you for making your home like her home, warm and comfortable.
Your kindness and efforts go far beyond the patients and extend to their families and friends.
Everyone who cared for my wife was, without exception, caring, kind, and exceptionally capable individuals who seemed to truly care about her well-being and care.
Your staff (at Hospice Home) was confident, thoughtful, kind and very loving to my mom. When we couldn’t be there or take care of her needs, you took care of her.
My mother spent her last days in your facility. I want to thank you for the gifts you gave to her and our family. The dignity, caring, professionalism, and kindness will remain a bright part of our saying goodbye to our mother.
My family and I would not have made it without Hospice.
For many veterans, military service is the most important thing that they have done in their lives.” As part of We Honor Veterans, those patients are now paired with a volunteer who also served in the military and share a common bond.
Thank you for all of your care, concern, education and kindness during Mom’s last year. My grief journey has had a lighter backpack because of Hospice.
Their touch, their time, their words were the comfort of a lifetime.
We were privileged to have the support of (Hospice)…They nurtured and cared for my husband as if he was their only patient.
Me consuela saber que mi esposa tuvo los mejores cuidados gracias a Hospice. La ayudaron a ella y a nuestra familia en todas las maneras posibles.
I thank God for putting good people in the right job for people like me.
We were so impressed by your staff and your desire to help us. No one wants to need Hospice, but when a person does, it is a tremendous blessing. Thanks again for the care you gave my dad, and ultimately all of us.
I would like to say that you have a beautiful Hospice Home. It is so nice and serene. I love the “quiet spots” that you can go to and meditate. Thank you so much in helping make my mother’s last days on this earth a little better and comforting.