Health Care Professionals –

Directions: Fax completed forms to Haywood Street Respite at 828-348-0933 along with H&P other pertinent documents. Call respite at 828-676-6756 to confirm that fax was received.  Haywood Street staff will evaluate the appropriateness of the referral and will contact you by phone to confirm approval.

A few things to know about us:

• We are a non-skilled facility; patient must be independent with activities of daily living.
• The typical length of stay at Haywood Street Respite is 2 weeks.
• While reservations are not possible, a phone call to explore appropriateness of referral and inquire about openings is welcome. 828-676-6756.

Required Forms to fax over to initiate review of a referral –

Screening Evaluation Form (to be completed by health care professional)

Respectful Living Covenant (to be reviewed and signed by patient)

• We will respond to referrals within 48 hours. Upon acceptance of referral, patient must arrive to Respite by 2 pm. 
• Discharge Instructions must accompany patient to Respite.
• Patients must arrive at Respite with two weeks’ worth of medications according to Discharge Instructions..
• Whenever possible, we will arrange to come pick up the patient. Please call to arrange after referral has been accepted. 828-676-6756.