Hope Forms

The forms below are only for patients or families who have been asked to download them by a Hope Hospice staff member. If you haven’t spoken to anyone about these forms, you don’t need to complete them online.

For those who have been asked to download forms:

  1. Print the appropriate forms below. (A Hope Hospice employee will tell you which ones you need.)
  2. Complete the forms by hand.
  3. Fax completed forms to (239) 482-6259
    - or-
    Scan the forms and email them to help@hopehospice.org.
  4. Make a copy of the form for your own records.
  5. Send the original copy to Hope Hospice. (State law requires us to keep your original signature). Please mail forms to:

    Care Resources
    Hope Hospice
    9470 HealthPark Circle
    Fort Myers, FL 33908

You will need Acrobat Reader to open these pdf files. If you experience problems, you can download the free software update.

Hospice Benefit Election
Hospice Benefit Election		 Patient Rights
Patient Rights		 Informed Consent
Informed Consent
Authorization to Disclose Protected Health Information
Authorization to Disclose Protected Health Information		 Medicaid Packet
Medicaid Packet		 Notice of Privacy PracticesNotice of Privacy Practices