Send a referral — phone, fax, or text.
Whatever works for you. We accept the script, face sheet, and doctor’s notes — no special form required.
Note: The phone, fax, and text number above is a placeholder — please confirm with the team before launch.
What we need from you
The form below is a resource, not a gate. The standard referral packet works fine — we’ll handle the rest.
- Script — physician’s order for skilled home health.
- Face sheet — demographics, insurance, contact info.
- Doctor’s notes — relevant clinical history.
- Any preferred care timeline — helpful but not required.
Already have a packet ready?
Fax it to (317) 669-6685 or call to coordinate. We’ll review and follow up promptly.
Send us a referral online
Helpful when fax isn’t convenient. Attach a packet by replying to our follow-up email.
Three ways to send a referral
No special form required. Send the script, face sheet, and notes by whichever method is easiest for your office.
Fax
Fax the packet to (317) 669-6685. Include a cover sheet with the referring provider’s name and callback number.
Download referral formPhone or text
Call or text (317) 669-6685 to reach our intake team directly and coordinate the packet.
Call intake nowOnline form
Use the online referral form above when fax isn’t convenient. We’ll follow up to securely collect the packet.
Open online formReferrals reviewed promptly
We aim to review every complete referral the same business day it’s received.
Talk to a real person
One number reaches our intake team by phone, fax, or text — no phone-tree runaround.
Place hard-to-place patients
We take Medicaid patients many other agencies turn away — a reliable option for your discharges.
What happens after you send the packet
Care begins after our clinical team reviews and confirms the referral.
You send the referral
Phone, fax, text, or online form — whatever works.
We confirm receipt
Our team acknowledges and reviews completeness.
Clinical review
The clinical team reviews the order and patient information.
Care plan & assignment
We build the plan of care and assign appropriate clinical staff.
First visit scheduled
We coordinate directly with the patient or family to begin care.
Reliable continuation of care
We’re built to be a dependable partner in your patients’ ongoing care journey.
We accept Medicaid
Many agencies won’t. We will. This is the most-cited reason partners refer to us.
Phone, fax, or text — your choice
One number works for all three. No special form required.
30+ years of leadership experience
Clinical operations led by people who’ve worked in home health for decades.
Shared admin across three brands
Backed by the operations infrastructure of Guardian Care and Indiana Family Caregivers.