Serving Your Community With Quality Home Care
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Services We Offer
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Contact Information
2280 Lancaster Pike, Shillington, PA 19607
Phone: (610) 743-3537
Fax: (610) 743-3537
Email: rhcs.services@gmail.com
Send Your Referrals
We thank you for taking an interest in our home health agency. We will be happy to work with you in developing a care plan that is especially fit for your client. To submit your referrals, please use our online form below. Confidential patient information will not be shared with third parties.
* = Required information
Client Referral Form
Referrer Information
Your Name
Your Organization
Tel. No.*
Client's Last Name*
First Name
Tel. No.*
Client's Address*
Contact Person*
Contact Person's Tel. No.*
Insurance Information
Client Information
Client's Date of Birth
Client's Medicare Number
Has the client ever received home health care service in the past?
Patient lives in a
Is the client able to drive a care safely on a regular basis?
Does the client use any type of assistive device ex. cane, walker, wheelchair?
Is the client willing to receive home health care services?
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Reading Home & Community Supportive Services does not discriminate against any person on the basis of race, color, national origin, disability, or age in employment.