Referral Forms

Please note: Both forms are designed for electronic completion

Specialist Palliative Care Referral Form

Registered Patient Referral Request Form


Make a referral

As an organisation working separately from the NHS, we require detailed information at the time of referral.

We have a shared referral process for our services with the Primary Care Trust based Macmillan Clinical Nurse Specialist service. Our combined Specialist Palliative Care Referral Form, for a patient not previously known to St Wilfrid's Hospice or the Macmillan team, can be emailed or faxed to us. If you are unsure of which service is most required, it may be that you request for us to triage the patient for the most appropriate service.

For urgent referrals, we will do our best to meet the need within one working day, but please call us to highlight that an urgent referral has been emailed or faxed.

Where patients are known to St Wilfrid's Hospice or the Community Macmillan team, additional requests for any of our services, including admission, can be submitted using the Registered Patient Referral Form, via email or fax. Patients who have been discharged from our service can be re-referred using this form.

Contact us to discuss referring a patient:

Tel: 01323 434200

For submission of a completed referral form:

Email (via email address):

Fax: 01323 640409


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