Anyone can refer a patient for a hospice or palliative care evaluation. Our HomeMD primary care practice is currently closed to new patients due to overwhelming demand. We hope to accept new patients in the fall 2022.

The form below is intended for use by patients, family members or friends. Once your form is submitted, someone from our Referral Center will follow up with you. If you prefer to speak to someone immediately, you can call us at 888-287-1255 for hospice or 888-283-1433 for palliative care.

If you are a healthcare professional please click here

Which type of service are you requesting?:*

Patient's Information:

First Name:*

Last Name:*

Date of Birth:

Current Location:*

Location Detail:

Telephone:*

Diagnosis:

Primary Care Physician

First Name:*

Last Name:*

Telephone:*

Additional Physician Following Patient (if known):

First Name:

Last Name:

Specialty:

Telephone:

Your Information:

First Name:*

Last Name:*

Telephone:*

Email:

Relationship to Patient*

Other:

Is the patient aware of your inquiry for a consultation?*

Who is the best person to coordinate the appointment with? :

if same as above select the checkbox

First Name:*

Last Name:*

Telephone:*

Relationship to Patient*

Other:

Please provide any pertinent information that prompted you to reach out to Care Dimensions for this patient:

How did you hear about Care Dimensions?*

Add me to your community newsletter mailing list

For verification purposes click the button below.

Since 1978, Care Dimensions has provided comprehensive and compassionate care for individuals and families dealing with life-threatening illnesses. As the non-profit leader in advanced illness care, we offer services in over 100 communities in Massachusetts.

Privacy | Terms of Use

888-283-1722

Call us now at 888-283-1722

24/7 Referrals and Nursing Support

Make a Referral

Patient's Information:

Primary Care Physician

Your Information:

Is the patient aware of your inquiry for a consultation?*

Please provide any pertinent information that prompted you to reach out to Care Dimensions for this patient:

How did you hear about Care Dimensions?*

Add me to your community newsletter mailing list