---
title: Hospice Care Information Request Form Template | Paperform
description: Compassionate hospice care information request form template. Collect patient needs, care preferences, insurance details, and schedule family consultations with ease.
url: "https://paperform.co/templates/hospice-care-program-information-request-form"
type: static
generatedAt: "2026-03-28T00:44:08.935Z"
---

[← Back to free form templates](/templates/)    ![Hospice Care Program Information Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-program-information-request-form.png)
    [Preview](https://_preview.paperform.co/ai-template/hospice-care-program-information-request-form) [Use this template for free](/create?ai-template=hospice-care-program-information-request-form)    [Contact Forms](/templates/category/contact/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Senior Care](/templates/industry/senior-care/)[Hospice & Palliative Care](/templates/industry/hospice/) [Nurse](/templates/role/nurse/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Caregiver](/templates/role/caregiver/)     About this free form template
### Professional Hospice Care Information Request Form

When families are navigating the difficult journey of end-of-life care, having clear, compassionate information is essential. This **hospice care information request form** makes it simple for patients, families, and caregivers to learn about hospice services, understand care options, and connect with a care team that can provide guidance during this sensitive time.

#### Why use Paperform for hospice care inquiries?

Hospice care providers need to balance professionalism with warmth, efficiency with empathy. This form template is designed specifically for **hospice programs, palliative care organizations, and senior care facilities** who want to make the information-gathering process as gentle and supportive as possible.

With Paperform's flexible form builder, you can customize this template to reflect your organization's compassionate approach. The document-style editor lets you add reassuring messaging, photos of your care team, and calming imagery that helps families feel supported from the very first interaction. You can match your organization's colors and fonts to create a seamless, branded experience that builds trust.

#### What makes this hospice information request form effective?

This template goes beyond basic contact details. It thoughtfully collects:

 - **Patient condition and care needs** to help your team understand the level of support required
 - **Preferred care setting** (home, facility, or residential hospice) to match families with appropriate programs
 - **Insurance and coverage information** to streamline eligibility conversations
 - **Spiritual and cultural care preferences** to honor each patient's beliefs and values
 - **Family consultation scheduling** to connect loved ones with your team quickly

The form uses conditional logic to show relevant questions based on earlier answers, ensuring families only see what applies to their situation. This reduces overwhelm during an already challenging time.

#### Seamless workflows for your care coordination team

When a family submits this information request, your team needs to respond quickly and compassionately. With **Stepper** ([stepper.io](https://stepper.io)), Paperform's AI-native workflow automation tool, you can automatically:

 - Send a warm, personalized email acknowledgment within minutes
 - Route urgent inquiries to on-call care coordinators immediately
 - Add family details to your CRM or patient management system
 - Schedule follow-up calls and assign care consultants
 - Create tasks for sending information packets, brochures, or welcome materials
 - Trigger different workflows based on care urgency or insurance type

Stepper helps your team stay organized and responsive, so no family falls through the cracks when they need you most.

#### Built for healthcare organizations that care about every detail

This template is ideal for:

 - **Hospice care programs** looking to modernize intake and inquiry processes
 - **Palliative care teams** who want to offer dignified, accessible information
 - **Senior care facilities** expanding end-of-life care services
 - **Hospital social workers** connecting patients with community hospice resources
 - **Faith-based care organizations** serving specific communities with cultural sensitivity

Paperform is **SOC 2 Type II compliant** and designed with security and privacy in mind, so you can collect sensitive healthcare and family information with confidence. While Paperform is not HIPAA compliant, this information request form is appropriate for pre-enrollment inquiries and initial consultations that don't involve protected health information.

#### Appointments, resources, and next steps—all in one place

Need to schedule family consultations directly from your form? Add Paperform's **appointment booking fields** to let families choose available time slots with your care coordinators. Connect your team's calendars and eliminate phone tag during an emotionally difficult time.

You can also attach PDF brochures, care philosophy documents, or insurance guides directly to your confirmation emails, ensuring families have the resources they need immediately after submitting their request.

#### A form that reflects your mission of compassionate care

Families reaching out for hospice information are often in crisis, grief, or uncertainty. The way you present your services matters. With Paperform's design flexibility, you can create a form experience that feels like a warm embrace rather than a cold intake process—professional but never clinical, thorough but never overwhelming.

Whether you're a small community hospice or a regional palliative care network, this template helps you meet families where they are with dignity, clarity, and care. Customize it to match your voice, add your team's story, and start connecting with families who need your support.

**Get started with this hospice care information request form template today** and create a better experience for the families you serve.
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