Refer A Loved One


Thank you for considering Amity Care Hospice services in caring for your loved one.  We recognize how challenging it can be to make a call such as this.  We want you to know that we are honored by your request and will do our best to provide the love and compassion that you want for your loved one.  You can reach us by calling 678.402.5235.  Your call is important to us and, in order to assist you, it would be helpful if you could have the following information handy:

  • Your name
  • Your relationship to the person who needs assistance
  • The best time to contact you
  • Your most pressing concerns or needs whether it be:
  1. Pain and/or symptom management
  2. Help with medication
  3. Help in understanding the illness
  4. Assistance with self-care (bathing, dressing, eating, etc.)
  5. Support for family
  6. Making decisions about care options
  7. Help with coping emotionally or any other concerns
  8. Location of the person needing assistance
  9. Their physician’s name and phone number.

If you wish, you can also email that information to our Clinical Director, Valerie Tapper, RN, BSN, CHPN, at

Again, we welcome the opportunity to serve you and those you love.  In the midst of this transitional time, we wish you peace.

Refer A Loved One

Thank you for considering care from Amity Care Hospice.  Please take a moment to fill out the form below.  We will contact you to discuss further details as soon as possible.

If you have an urgent need please contact us immediately by calling 678.402.5235


Your Contact Information

First Name *

Last Name *

Phone Number *

What is your relationship to the person who needs assistance? *

What is the best time of day to contact you?

What are your most pressing concerns or needs?
(Please check all that apply)

Pain and/or symptom management

Support for family

Help with medication

Making decisions about care options

Help in understanding the illness

Help with coping emotionally

Assistance with self care (bathing,dressing, eating, etc.)


What is the current location of the person needing assistance?

Current Doctor Information

Dr’s First Name

Dr’s Last Name

Dr’s Phone