Hospice of Holland
270 Hoover Blvd.
Holland, MI 49423
Ph (616) 396-2972
Fx (616) 396-2808

Please contact us by mail, phone or use our email form below:

Hospice of Holland, Inc.
270 Hoover Blvd.
Holland, MI 49423

(616) 396-2972 (800) 255-3522


Field names that are bold indicate required fields.


E-mail Address:
Name:
Address:
City:
State:
Zip:
Phone:

Reason for contact:

I would like more information on Hospice of Holland

I would like more information on Hospice House

I would like to refer my loved one to Hospice of Holland.
(Please list the name and address of your loved one in the comment box below.)*

I would like to speak to someone regarding your bereavement programs and support groups.
I am interested in volunteering for Hospice of Holland.
I would like to make a donation.
I would like more information on planned giving to Hospice of Holland.
I would like someone from Hospice of Holland to speak to my organization.
I would like more information on Hospice of Holland's fundraising events.

* When contacting you to refer your loved one, our admissions counselors will ask specific questions to fill out the referral form:
  1. Patient name, address and phone number.
  2. Age and social security number.
  3. Primary diagnosis.
  4. Name of attending physician and if that physician has given verbal authorization for Hospice care.
  5. Insurance information.
  6. Name of primary contact person.
  7. Where the patient is currently located, i.e. hospital, etc.