If you are a healthcare provider or a patient/family member and wish to request the services of HonorView hospice, simply fill out our clinical referral form. (*) required fields Patient's First Name* Patient's Last Name* Patient's Phone Number* Relationship*—Please choose an option—PatientFamilyDoctorFacility Your First Name* Your Last Name* Your E-mail Address* Your Phone Number* Message Face-sheet / H&P / Hospice Order / Discharge Summary