Make a Referral

Agape Hospice Care stands ready 24/7 to assist you or a loved one in need of hospice.

New Patient Referrals


Use the form below to begin the process of admitting a loved one for hospice care.

For Immediate Assistance please call (404) 763-1456. We are available 24/7.

IMPORTANT: By completing this form, you agree to be contacted by or receive information from Agape Hospice Care.

Your privacy is important to us. Please read our privacy policy for more information. *All fields are required.

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Doctor/Hospital/ALF Referrals


Agape Hospice Care operates under three (3) licenses.

AGAPE HOSPICE CARE OF CAROLLTON, LLC. NPI#: 1275895419

AGAPE HOSPICE CARE OF NORTHEAST GA, LLC. NPI#: 1932538964

AGAPE HOSPICE CARE OF CHEROKEE COUNTY, LLC. NPI#: 1043708803

Referrals to Agape Hospice Care can be made through:

ALLSCRIPTS, EPIC, and NAVISTAR

Agape Hospice Care accepts fax referrals/transfers.

If you prefer to make referrals or transfers by Fax, please download the appropriate form(s) below.

Please fax forms to (866) 682-6164.

For Immediate Assistance please call (404) 763-1456. We are available 24/7.

24/7 CARE LINE

(404) 763-1456