Thank you for referring your hospice-eligible patient to Cypress Basin Hospice. Complete the form below to submit your secure referral.

If you are a clinician who prefers to speak to us in person, call 903-577-1510 to make a referral over the phone. You may also submit pertinent medical information to our intake fax at 903-577-9377 (eg: face sheet and demographics, history and physical information).

  • Your Name: * Required
  • Patient Name: * Required
  • (home address or facility name)
  • Primary Caregiver: * Required