Testimonials

It is during times of need, during stressful situations, the challenge of taking care of the elderly that one can only hope that those who are designated to offer and respond to your needs "are there and fulfill their other part of the challenge" which in this case was United HomeCare, and it was performed.

Bertha A., Caregiver

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Customer
Care Center

Community Service Referral

Please fill in the form below. In order to fax or mail, please print this form and return it to:

United HomeCare
Customer Care Center
8400 N.W. 33rd Street, Suite 400
Miami, FL 33122
Email: customercare@unitedhomecare.com
Fax: (305) 639-3093

Or call us at (305) 716‐0710 and a representative will help you complete this form over the telephone.

Date of Referral:

Referred by:

Source Name:

Telephone:

Email:

Client Information:

Name:

Date of Birth:

Sex:

Female Male

Contact Phone:

Contact Email:

Caregiver Info (if applicable):

Contact:

Relationship:

Preferred Language:

Spanish English Creole Other

If other, specify:

Optional:

Physician Name:

Telephone:

Medicare Referral: If skill services are needed, please submit Physician Order and Fact Sheet.

Comments:

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