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Is Palliative Care Right for You?

Answer the following questions to determine whether palliative care might be right for you or someone close to you. Remember, you can receive palliative care at any point in your illness.  Palliative Care Services does require a doctors signature.

If you think you may be appropriate for palliative care, you have the option to download the screening tool, fill it out and fax it to our office @ 513-528-8151.  We would then be in contact with you to obtain your Primary Care Physicians contact information to gain the referral.

  • Date Format: MM slash DD slash YYYY
  • Does this client have any of the following? (check all that apply)
  • If so, do they have any of the following? (check all that apply)