Admission to our agency can only be made upon recommendation of a physician, based on the need of the client, homebound status [in some cases], and the type of services required that this agency can provide. However, if you know someone that you feel would benefit from our services, we would be glad to take a referral from you and contact the client and their physician for possible admission to our agency.

Referrals can be made by either contacting our office, filling out a referral form and faxing it to (937) 254-6292, or filling out the brief form below. Click the link below to download our referral form.

Choice Home Health Care Referral Form in PDF format

Please feel free to fill out the form below.  If we accept the referral we will call you and obtain more information such as SS#, Insurance #'s, etc.