Make A Referral

Make a Referral

Thank you for reaching out to Dignity Hospice of Colorado. Complete the form below to submit your secure referral. If you are a clinician who prefers to speak to us in person, call 720-222-3315 to make a referral over the phone.

Patient's Name*
First Last
Patient's Phone Number
Your Name*
First Last
Your Phone Number*
Your Email*
Your Relationship to Patient*
Patient's Diagnosis
- Alzheimer's/Dementia
- Cancer
- COPD
- CHF
- Other
Patient's Current Location*
File Upload
Max. file size: 10 MB.
If you are with a community or hospital, you can upload patient documents here.