Home Visiting Hub

Pilgrims Hospice Society is pleased to provide our Home Visiting Hub program, which offers home visits from primary palliative care physicians and specially trained nurses. This service bridges the gap for those with a life-threatening progressive illness who live at home but do not have access to a primary care provider.

* Required Fields
Referral for Physician Home Visiting Form:
Name of Person Making the Referral*
First Last
Your Email*
Phone*
Client's Name*
First Last
Date of Birth (MM/DD/YYYY)*
MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone*
Emergency Contact Name
First Last
Emergency Contact Phone
Primary Diagnosis*
Reason for Referral*
Alberta Healthcare Number (PHN)*
Goals of Care Designation*
Social Situation*
Palliative Blue Cross*
- Yes
- No
Current Primary Care Practitioner
(If Applicable)
Security Check
Name
This field is for validation purposes and should be left unchanged.

Contact Us

When contacting us, be prepared to leave a message and we will return your call based on urgency. Please make sure to have the following:

Name of the community client you are calling about
Name of your primary palliative care physician
Your name, number and relation to the client
Reason for your call (please be as specific as possible)

Referral calls will be returned within two business days. Calls regarding current patients will be returned within one business day or more quickly if the call is urgent (see examples below).

Examples of non-urgent calls are rescheduling an appointment, non-urgent prescription renewal, message for a physician, minor change in health status and expected death in the home.

Examples of urgent calls are a pain crisis that has not improved with breakthrough medication, sudden change in consciousness, uncontrolled symptoms and severe discomfort.

Contact us:
Phone: 587-415-3537
Email: homevisits@pilgrimshospice.com

Home Visiting Hub

Referral for Physician Home Visiting Form:

Contact Us