Healthcare Partners

Safe discharges. Smoother transitions. Better outcomes.

For hospital case managers, discharge planners, rehab coordinators, and facility social workers — submit a referral and we'll handle intake, family communication, and caregiver placement.

24hr

Rapid Response

We contact the family within 24 hours of referral — often within 2. Urgent discharges are our specialty.

48hr

Care in Place

From referral to active caregiver on-site — usually within 48 hours, with same-day capabilities when needed.

100%

Follow-Through

We close the loop — confirming intake, reporting status to your team, and flagging concerns proactively.

Referral Form

Submit a referral.

Use this form to refer a patient for non-medical home care. Fields marked with an asterisk are required; everything else helps us be more effective.

01 Referring organization

Organization Name *

Organization Type *

Organization Address

02 Referring contact

Your Name *

Title / Role *

Email *

Direct Phone *

Fax (optional)

Best Way to Reach You

03 Patient information

Please only include information you're authorized to share per HIPAA. For sensitive details, please use our secure fax line or call directly.

Patient Name *

Age

Patient Phone

Discharge Address (City & Zip) *

Primary Family Contact If the family has designated a primary contact, please include their details.

04 Clinical context

Reason for Admission / Current Care

Anticipated Discharge Date

Relevant Diagnoses / Conditions

Mobility Status

Cognitive Status

Fall Risk

Patient Lives With

06 Additional notes

Special Considerations

Protected health information should be shared in compliance with HIPAA. For sensitive details, please call us directly at (505) 546-4323.

Referral received — thank you.

Our intake team will contact the family within 24 hours and follow up with you directly on status. For urgent cases, please also call (505) 546-4323.