Rainbow Kidz Referral Form

Thank you for your interest in Rainbow Kidz! Rainbow Kidz is the pediatric grief program of Hospice and Palliative Care of Iredell County. Our services are provided at NO COST to our families, schools and our community.


Please complete this referral form so that we can determine the Rainbow Kidz counselor that will follow up with you.


If you have more than one child, please complete a form for each child. Thank you!