• Is Palliative Care Right For You?

    Please answer all questions
  • Have you been diagnosed with one or more serious illnesses? cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), emphysema, lung disease, dementia/Alzheimer’s, kidney diseases, liver failure, neurological diseases (ALS, MS, Parkinson’s)*
  • Are you experiencing or do you often struggle with one of the following? pain, shortness of breath, fatigue, nausea, poor appetite, anxiety or depression*
  • Have you noticed it becoming harder to do everyday activities like bathing, dressing, cooking, or walking?*
  • Have you been to the emergency room or hospitalized more than once in the past six months?*
  • Do you find yourself needing to call your doctor frequently because of your illness?*
  • Has your illness been getting worse despite treatment?*
  • Would you or your family/caregiver benefit from assistance with any of the following needs? Understanding your illness or what to expect. Discussing and understanding the benefits and burdens of treatments (such as dialysis, curative cancer treatment, surgery, etc.). Discovering what programs and resources are available to aid you. Feeling overwhelmed and coping with the stress of a serious illness. Emotional, spiritual or religious support.*
  • Would you benefit from increased communication and discussions regarding your healthcare goals and future wishes with your healthcare provider team?*
  • Should be Empty: