Editha House

Editha House is a place where patients and caregivers find comfort and emotional support in one another. We understand the challenges you are facing and are here to welcome you with open arms.

How You Can Help



Editha House is a proud member of the Healthcare Hospitality Network


"As a breast cancer survivor, I am honored to give back by bringing fresh flowers and vegetables to Editha House."

    ~ Marilyn H., Phoenix

Online Referral Form

All information must be completed by a Referring Agent.

REFERRAL INFORMATION
Referral Agent *
Title *
Email *
Phone
Date of Referral *
Medical Facility *
PATIENT INFORMATION
Patient Name *
DOB *
Street *
City *
State *
Zip Code *
Gender Male Female
Home Phone
Cell Phone
Miles from Residence to Treatment Facility *
Email Address
Diagnosis *
Treatment *
Name of Employer *
Are there any medical problems which may affect the patient's condition while staying at Editha House?
Speaks and/or understands English? Yes No
Has an infectious disease or infectious disease symptoms? Yes No
Been convicted of a violent crime, domestic violence, crime against a child, theft, and/or illegal drugs? Yes No
On probation or parole? Yes No
Has a civil protection order against them? Yes No
Been required to register on the state or National Sex Offender Registry? Yes No
Are you a smoker? Yes No
TREATMENT INFORMATION
Treatment Start Date
Treatment End Date
Estimated Time of Arrival
Treatment Facility
Street *
City *
State *
Zip Code *
DOCTOR INFORMATION
Patient's Doctor
Phone
Fax
Email Address *
Street *
City *
State *
Zip Code *
CAREGIVER INFORMATION
Caregiver Name
DOB *
Street *
City *
State *
Zip Code *
Gender Male Female
Home Phone
Cell Phone
Relationship to Guest *
Speaks and/or understands English? Yes No
Has an infectious disease or infectious disease symptoms? Yes No
Been convicted of a violent crime, domestic violence, crime against a child, theft, and/or illegal drugs? Yes No
On probation or parole? Yes No
Has a civil protection order against them? Yes No
Been required to register on the state or National Sex Offender Registry? Yes No
Are you a smoker? Yes No
COMMENTS
Additional Comments
VERIFICATION
To verify your humanity, please answer the following: 4+3= *


There is a three (3) night minimum stay required.

For those who can afford it, a donation is appreciated.

Check-in is by appointment only between 8:00 am - 8:00 pm. Upon arrival, guest and caregiver will supply Editha House with a government-issued photo ID (State ID, Driver's License, VA Card, etc.) for admittance.

Please call 602-388-4920 with any questions.


Editha House accepts all guests that are receiving active treatment. All individuals who meet the eligibility requirements are welcomed at Editha House, when room is available; regardless of race, creed, citizenship, disability, gender, gender identity, color, ethnicity, heritage, veteran status, economic status, or sexual orientation.