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Is it Time for Hospice?

At Astral Hospice and Palliative Care, we understand that deciding when to seek hospice care can be overwhelming. If you or a loved one is experiencing a serious illness, completing the form below will help us assess your situation. Once the form is submitted, a compassionate member of our team will be in contact with you to provide a free assessment and personalized guidance. All hospice services, including in-home care, are provided at no cost to you.

Has the patient been diagnosed with a life-limiting illness? (e.g., cancer, heart disease, lung disease, dementia)
Yes
No
Is the patient's condition worsening despite treatments?
Yes
No
Has the patient had frequent hospital admissions or emergency room visits recently?
Yes
No
Does the patient prefer to focus on comfort rather than curative treatment?
Yes
No
Has the patient experienced significant weight loss or a decrease in appetite?
Yes
No
Is the patient experiencing uncontrolled pain or other severe symptoms (e.g., difficulty breathing, nausea)?
Yes
No
Does the patient need regular assistance with personal care tasks? (e.g., getting out of bed, using the restroom)
Yes
No
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