Doctor Referral Request

Thank you for your interest in our services. Your doctor will need to determine if you qualify for home care services. If your doctor thinks you are a good fit for home care, he/she will need to submit a referral to us for your care.

At your next doctor's appointment, let your doctor know you'd like to receive home care services from MercyOne Home & Hospice Care. Select and print your referral form below and bring it with you to your appointment.