Seahorse referrals - Professionals

If you are not the main caregiver, have you asked for consent to make a referral on their behalf?(Required)

Professional details

Name(Required)

Carer's details

Main carer's name(Required)

Young person's details

Their name
As we move towards joined-up working with other healthcare organisations, providing us with your unique NHS number enables us to quickly and accurately find you and the people most important to you, to facilitate improved care, treatment, counselling and support.
DD slash MM slash YYYY
Their address
What is their gender?
What is their religion?

How do they describe their sexual orientation?

Is the young person aware that a referral is being made?(Required)
Was the deceased under hospice care?(Required)

Child's Next of Kin

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Contact us

St Wilfrid’s Hospice

1 Broadwater Way

Eastbourne

East Sussex

BN22 9PZ

Phone: 01323 434200

General enquiries: hospice@stwhospice.org

Patient-related enquiries or referrals: stwh.spcreferrals@nhs.net

Click for our Contact us page

Information
About us
Company information

Registered in England and Wales
Company number: 1594410
Registered charity number: 283686
VAT number: GB 322 9910 05

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