Refer a Patient

Please complete the information below to submit a patient referral to Safe Zone Homes. Our team will review and follow up within 24 hours.
Blank Form (#3)

Referral Criteria

Safe Zone Homes is intended for medically stable patients requiring short-term supervised recuperative care following hospital discharge.

Appropriate Referrals
  • Post-surgical recovery
  • Fall-risk supervision
  • Wound recovery with home health
  • Oral antibiotic recovery
  • Unsafe home environment
Exclusion Criteria
  • Psychiatric stabilization
  • Substance detoxification
  • 24/7 skilled nursing
  • Active IV therapy
  • Total-care assistance

Referring Provider Information

Patient Overview

Basic patient demographics and discharge information.

Clinical Stability Verification

Confirm the patient is appropriate for a supervised non-medical recovery setting.

Mobility & Support Needs

Help us understand the patient’s mobility level and recovery support requirements.

Behavioral & Safety Considerations

Identify any concerns that may impact placement appropriateness or supervision needs.

Exclusion Criteria

Safe Zone Homes cannot accept patients requiring psychiatric stabilization, violent behavior management, active substance detoxification, or intensive skilled nursing care.

Recovery & Placement Notes

Share any additional discharge barriers, placement concerns, or recovery considerations.

Our team reviews referrals promptly and typically responds within 24 hours.