Referral Program – Divine Serenity Home Health

Divine Serenity Home Health Referral Program!

Welcome to the Divine Serenity Home Health Referral Program!

Thank you for being a part of the Divine Serenity Home Health family and for helping us reach more individuals in need of our compassionate care.

Together, we can make a difference in the lives of those we serve. Thank you for your support and referrals!

Ready to start referring clients and earning commissions? Simply fill out our online referral form and provide the necessary information about the client you are referring. Our team will take care of the rest!

Thank you for being a part of the Divine Serenity Home Health family and for helping us reach more individuals in need of our compassionate care.

For more information about our referral program, please contact us at contact@divineserenityhh.com.

Together, we can make a difference in the lives of those we serve. Thank you for your support and referrals!

Referral Form

Referrer Information:

Single Line Text

Organization:

Phone *

Email *

Patient Information: *

Date of Birth: *

Address

Address Line 1

City

State

Zip Code

Phone :- *

Primary Care Physician: *

Diagnosis/Condition: *

Requested Services: *

Referral Details: *

Expected Start Date: *

Frequency of Services: *

Special Instructions/Notes: *

Checkboxes *

Compliance Acknowledgment:

by submitting this referral form, I acknowledge and agree to the following: - I certify that this referral is based on the patient's clinical and care needs and is not influenced by any financial incentives or remuneration. - I understand and agree to comply with all applicable laws and regulations, including the federal Anti-Kickback Statute, Stark Law, and other fraud and abuse laws. - I certify that Divine Serenity Home Health Care will provide services based on the patient's clinical needs and will not offer or accept any form of kickbacks or inducements for referrals. Signature: Date:

Website

Divine Serenity Home Health Referral Program!

How it works:

Referral Form

Contact Info

Important Pages

Get In Touch