About
Services
Events & News
Get Involved
Contact
Referral

About
Services
Events & News
Get Involved
Contact
Referral Form

About
Services
Events & News
Get Involved
Contact
Referral Form

Facility Rental

Preceding Day

Monday, March 04, 2024

Following Day

Monday, March 4, 2024
6:30pm - 8:00pm
Booked Missy Bee Canva :: Facility Rental

Get Involved

Ways to Donate

Corporate and Community Supporters

Volunteer Spotlight

Become a Member

Commemorative Path

Volunteer Calendar

No events

Room Availability

Last month

August 2029

Next Month

S	M	T	W	T	F	S
			1	2	3	4
5	6	7	8	9	10	11
12	13	14	15	16	17	18
19	20	21	22	23	24	25
26	27	28	29	30	31

1107 French Settlement Road,
Kemptville, ON, K0G 1J0

613-258-9611

Office Hours

Monday-Friday
8:30am-4:00pm

Services

Day Hospice
In-Home Visiting
Network of Support
Education
Equipment Lending
Resource Library
FAQs
Grief & Bereavement

Get Involved

Ways to Donate

Corporate and Community Supporters

Volunteer Spotlight

Become a Member

Commemorative Path

© Beth Donovan Hospice 2025, Designed by ProbaseWeb

Charitable Registration # 896678661RR0001

Client Referral Form

Referral Information

Name of individual completing form *

Enter your email address *

Referral Source^*

Self

Friend

Family Member

Physician

Health Care Team Member

Other

Reason for referral (brief) *

Client Information

Name: *

Street Address *

Town/City *

Province *

Postal Code *

Year of Birth *

Phone Number *

Email Address *

Services of Interest^*

Day Hospice

Visiting Volunteer

Grief Bereavement Support / Counselling

Caregiver Support

Equipment Lending

Library Lending

click all that apply

Additional Information

reCAPTCHA *

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Name