Referral

Army Fisher Houses

The Army Fisher Houses provide a home away from home to families with a loved one receiving treatment at select military hospitals.
www.armyfisherhouses.org

REQUESTING A ROOM

Please complete this Referral Form. While not all information is required, it helps our staff to anticipate the level of support needed

Providers, case managers, chaplains, or other hospital staff should assist with completing and forwarding this form to the appropriate Fisher House for consideration.

Please note tat a referral to the Fisher House is NOT a reservation.

If approved, you will be provided additional information from the Fisher House where lodging is requested.

Due to our shared living environment, anyone with a potentially contagious illness or infectious condition is NOT appropriate to stay in the house.

Patients are not permitted to stay at the Fisher Houses alone, nor can we allow those with medical equipment attached for the collection of bodily fluids.

ARMY FISHER HOUSE REFERRAL FORM

For Official Use Only – Protected by the Privacy Act
Download and fill out the PDF form


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