Certification forms

Hospice care is appropriate for patients with a life-limiting illness and a prognosis of six months or less, who are aware of their situation and agreeable to receiving palliative care.  Physicians must certify that their patient is eligible and has expressed interest in receiving hospice care.

Please click to print the Certification Form and fax it to (831) 430-9272.
If you have a problem opening the forms, call us at (831) 430-3000.