Making a Referral

Your doctor, or Hospice can guide you through a conversation about whether a referral to Hospice is right for you.

In most cases, your specialist or your GP will make a referral to Hospice and discuss this with you. If you want to explore whether a referral is right for you, discuss this with your doctor, or give us a call. You can also make a referral directly to us yourself.

Not all patients who have a terminal diagnosis will need a Hospice referral. Your doctor can guide you through a decision on what care is best for you.

If you prefer to complete a paper form and email this back to us, please click here to download our referral form PDF.

Specialist Palliative Care Referral Form
  • Patient Details
  • Medical Information
  • Further Information
Urgency of Referral

Patient Details

Name
Name
First Name
Middle Name
Last Name
Address
Address
City
Region
Area Code
Country