Referral & Contact Information

There are several ways to contact us:

1. Call us Monday-Friday 8am to 4:30pm at 269-408-4322 or 1-855-243-8876
2. Click here to download a copy of our referral form
3. Complete the following online form. ( * = Required Field)

Your Name*
 

Your Phone Number*

I am interested in PACE for:*

Who should PACE contact for more information?*

Please provide the name, address, and phone number of the person who needs assistance:

Is the person referring 55 or older?*
 Yes No

Check all that apply:
 Needs assistance with transferring, feeding, toileting, catherer or ostomy care Confusion, dementia, memory concerns Daily oxygen use Shortness of Breath Daily Tracheotomy care End of Life Care Chronic ER visits (2 or more per month) Uses a cane, walker, or wheelchair

Please list the services or assistance that is needed? *

How did you hear about us?*

By clicking "Submit" below you agree to have a PACE representative contact you.

Click here to see if you qualify for PACE.

269-408-4322 | Toll Free: 855-243-8876| Fax: 269-408-4340 | 2900 Lakeview Ave. • St. Joseph, MI 49085