Is Now The Time For Hospice?

A terminal illness can be scary and overwhelming – but that’s where hospice can step in and walk with you on your journey. Shepherd’s Cove Hospice seeks to provide hospice care to anyone with a life-limiting illness, regardless of their ability to pay. Anyone can refer a patient (the patient can be yourself or a loved one) to Shepherd’s Cove, and the evaluation is 100% free.

If you’re not sure whether you or your loved one might be eligible to receive hospice care, the questionnaire below might help.

1) Been hospitalized or gone to ER several times in past 6 months?*
- Yes
- No
2) Been making more frequent phone calls to your physicians?*
- Yes
- No
3) Started taking medication to lessen physical pain?*
- Yes
- No
4) Started spending most of the day in a chair or bed?*
- Yes
- No
5) Fallen several times over the past 6 months?*
- Yes
- No
6) Started needing help with one or more of the following? (bathing, dressing, eating, getting out of bed, walking)*
- Yes
- No
7) Started feeling weaker or more tired?*
- Yes
- No
8) Experienced weight loss making clothes noticeably looser?*
- Yes
- No
9) Noticed a shortness of breath, even while resting?*
- Yes
- No
10) Been told by a doctor that life expectancy is limited?*
- Yes
- No
Your Name*
First Last
Email*
Hospice Candidate's Zip Code*
ZIP / Postal Code
Your Phone Number*