Get Involved - Refer Others

•	General Donation
•	Inpatient Facility Donation
•	Refer Others
•	Request a Speaker

Main Office:
309 E. Main Street
P.O. Box 474
Bennettsville, SC 29512
Phone: 843-479-5979
Fax: 843-479-3711
Email Us

Hartsville Office
202 South Second St.
Hartsville, SC 29550
Phone: 843-383-5115
Fax: 843-383-5915

Refer Others

Please complete the form below if you know of someone who would benefit from services at Helping Hands Hospice.

Name of Person who may quality for services:

Address:

City, State, Zip:

Phone:

Caregiver's Name:
(Person taking care of patient, if known.)

Caregiver's Home Phone:

Caregiver's Work Phone:

Disease/Diagnosis of patient: (if known)

Does the patient live alone?:

Name of Person Making Referral:
(or remain anonymous)

Home Phone:

Work Phone:

Relationship to Person Referred:

Other Comments: