I understand the $100 Service Credit is applied to my account after my referral becomes an active Helios Home Care patient. I confirm the person I am referring has not previously inquired with Helios Home Care. I confirm the contact information I am submitting for my referral is accurate. I understand the Service Credit will be applied within 30 days of confirmed patient activation

I consent to Helios Home Care contacting me regarding this referral via phone or email. I confirm all information submitted is accurate to the best of my knowledge