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Health Care Professionals –

Click here to review the referral process flow chart.

Next, read over the following documents with your patient.

Screening Evaluation Form

Respectful Living Covenant

Directions: Fax completed forms to Haywood Street Respite at 828-348-0933 along with H&P and other pertinent documents. Call respite at 828-575-2477, ext 102 to confirm that fax was received.  Haywood Street personnel will evaluate the appropriateness of your patient and will contact you by phone to confirm approval.

  • While reservations are not possible, a phone call to explore appropriateness of referral and inquire about openings is welcome.
  • Referral must be submitted before 2:00pm
  • Discharge Instructions must accompany patient to Respite.
  • Patients must arrive at Respite with medications according to Discharge Instructions
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