Referral Forms

Sequoia Home Health, Hospice & Companion Care offers both medical and non-medical services designed to seamlessly deliver appropriate, quality care for you, your patient, or loved one.

We appreciate that you have chosen us to be the provider of your home based needs. Whether you’re a medical professional or a family member, we look forward to hearing from you and partnering with you to ensure your home health and home care needs are met.

Our simple referral process allows you to quickly secure care without time-consuming paperwork. Please complete and print the forms you need, then submit by fax.

Express Referral Fax Number: 1.844.272.2818

Please don’t hesitate to contact us HERE with any questions you may have.

Get the Home Health Referral Form HERE.

(requires doctor’s signature)

Get the Companion Care Referral Form HERE.

Get the Hospice Referral Form HERE.