Book Appointment

Name: Lavender Hospice
Brand: Lavender Hospice
SKU: 6022833663
Rating: 5 (4 reviews)

If you’re not sure whether you or your loved one might be eligible to receive hospice care, this brief questionnaire might help.

Been hospitalized or gone to ER several times in past 6 months?

Yes No

Been making more frequent phone calls to your physicians?

Yes No

Started taking medication to lessen physical pain?

Yes No

Started spending most of the day in a chair or bed?

Yes No

Fallen several times over the past 6 months?

Yes No

Started needing help with one or more of the following? (bathing, dressing, eating, getting out of bed, walking)

Yes No

Started feeling weaker or more tired?

Yes No

Experienced weight loss making clothes noticeably looser?

Yes No

Noticed a shortness of breath, even while resting?

Yes No

Been told by a doctor that life expectancy is limited?

Yes No

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