Hospice Readiness Questionnaire
Please review the items below to see which apply to you.
- I make frequent calls to my physician.
- I have made frequent trips to the emergency room in the past six months.
- I have started feeling more tired and weak.
- I have fallen several times in the past six months.
- I take medicine to lessen physical pain.
- I spend most of the day in bed or in a chair.
- I experience shortness of breath, even when resting.
- I have noticed an increased weight loss in the past six months.
- I need help from others with important daily activities such as bathing, dressing, eating, cooking, walking and getting out of bed.
- My health care provider told me I have a life limiting illness.
If four or more items apply to you, speak to your medical provider or call Burke Hospice and Palliative Care at 828-879-1601.