WE ARE HERE. LET US HELP.
If you or someone you know is in need of help from Heart House, please complete the form below. Please provide as much information as you are able.
Once you hit the SUBMIT REFERRAL FORM button the form will be emailed to our secure and confidential email.You should receive a copy of the referral form to the email address you identified in the referee section. If you do not receive an email, please call 905-712-8119 ext: 255 to confirm your referral was received.
Or you can download and print the form and submit it to us by fax at 289-724-0620 or by email: intake@hearthousehospice.com.
We have TWO options below, please complete the form that is most related to your needs:
1: Bereavement Support
2: Hospice Counselling