Referrals 01

Referral forms

Referral form: In-patient, Hospice at Home and Day Services

Admissions to the Hospice can only be arranged via a GP, District Nurse, Macmillan Nurse, Hospital Consultant or other Hospice services. 

Referral forms are also available through HARMLESS.

Nomination form: Hospice Neighbours

Alternatively, if you have a patient who would like a Hospice Neighbour (a free service staffed by volunteers), please complete the Hospice Neighbour Nomination form.

Referral form: Hospice Bereavement Services
Members of the public can refer themselves to access our Bereavement Services.

Get in touch with our Clinical team


Referral forms should be downloaded and returned by email.

Family members and/or carers are welcome to contact us directly and talk to the Clinical Lead Nurse about how to access our Hospice services, please contact 01424 445177.

If you or your patient would like to know more about our Hospice Neighbour scheme please contact our Hospice Neighbour Team Leader on 01424 445177 or email us.