UNDERWRITING AGREEMENT

                                     BETWEEN

                       KBL HEALTHCARE ACQUISITION CORP. II

                                       AND

                             EARLYBIRDCAPITAL, INC.



















                       DATED: _____________________, 2005




                       KBL HEALTHCARE ACQUISITION CORP. II


                             UNDERWRITING AGREEMENT



                                                              New York, New York
                                                                 _________, 2005



EarlyBirdCapital, Inc.
275 Madison Avenue, Suite 1203
New York, New York  10016

Dear Sirs:

                  The undersigned, KBL Healthcare Acquisition Corp. II, a
Delaware corporation ("Company"), hereby confirms its agreement with
EarlyBirdCapital, Inc. (being referred to herein variously as "you," "EBC" or
the "Representative") and with the other underwriters named on Schedule I hereto
for which EBC is acting as Representative (the Representative and the other
Underwriters being collectively called the "Underwriters" or, individually, an
"Underwriter") as follows:

1. Purchase and Sale of Securities.

         1.1      Firm Securities.

                  1.1.1 Purchase of Firm Units. On the basis of the
representations and warranties herein contained, but subject to the terms and
conditions herein set forth, the Company agrees to issue and sell, severally and
not jointly, to the several Underwriters, an aggregate of 5,000,000 units ("Firm
Units") of the Company, at a purchase price (net of discounts and commissions)
of $5.58 per Firm Unit. The Underwriters, severally and not jointly, agree to
purchase from the Company the number of Firm Units set forth opposite their
respective names on Schedule I attached hereto and made a part hereof at a
purchase price (net of discounts and commissions) of $5.58 per Firm Unit. The
Firm Units are to be offered initially to the public ("Offering") at the
offering price of $6.00 per Firm Unit. Each Firm Unit consists of one share of
the Company's common stock, par value $.0001 per share ("Common Stock"), and two
warrants ("Warrant(s)"). The shares of Common Stock and the Warrants included in
the Firm Units will not be separately transferable until 90 days after the
effective date ("Effective Date") of the Registration Statement (as defined in
Section 2.1.1 hereof) unless EBC informs the Company of its decision to allow
earlier separate trading, but in no event will EBC allow separate trading until
the preparation of an audited balance sheet of the Company reflecting receipt by
the Company of the proceeds of the Offering and the filing of a Form 8-K by the
Company which includes such balance sheet. Each Warrant entitles its holder to
exercise it to purchase one share of Common Stock for $5.00 during the period
commencing on the later of the consummation by the Company of its "Business
Combination" or one year from the Effective Date of the Registration Statement
and terminating on the four-year anniversary of the Effective Date. "Business
Combination" shall mean any merger, capital stock exchange, asset acquisition or
other similar business combination consummated by the Company with an operating
business in the healthcare, or healthcare related, industry (as described more
fully in the Registration Statement).

                  1.1.2 Payment and Delivery. Delivery and payment for the Firm
Units shall be made at 10:00 A.M., New York time, on the third business day
following the effective date of the Registration



                                       1


Statement (or the fourth business day following the effective date, if the
Registration Statement is declared effective after 4:30 p.m.) or at such earlier
time as shall be agreed upon by the Representative and the Company at the

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