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Make a Referral

To refer a patient please call the Access Team at 410-742-7878 or use the Referral Form below. A member of the Access Team will handle the rest. If you are unsure about hospice, a member of the team can visit to discuss services and assess eligibility.

Patient Information
Patient Name*
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Zip Code*
Phone Number*
Contact Person Information (Person making referral)
Contact Name*
Phone*
Email
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Home | About Coastal Hospice | Coastal Hospice at the Ocean | Coastal Hospice at the Lake | Palliative Care Program | Support for Grief and Loss | Health Care Professionals
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2604 Old Ocean City Road | Salisbury, MD 21804 | 410-742-8732 | Fax 410-548-5669
PO Box 1733 | Salisbury, MD 21802

Coastal Hospice is a 501(c3) non-profit organization that relies on charitable support to provide its programs and services.

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