Refer a loved one

Accessing our services

We know that waiting for a referral through a medical professional can delay access to care. That’s why we offer a self referral process, so a patient, family member or carer can contact us directly.  

Our Patient Flow Team is here to help people living with life limiting and progressive illnesses to access our range of services, including respite, wellbeing, physiotherapy, complementary therapy, symptom management, family support, and end-of-life care.  

What is a self referral?

If you would like a loved one to access our services, you can reach out to us directly – there’s no need to go through a healthcare professional first.

Simply fill out the form below or call us on 01978 316806.  

Once you’ve contacted us, we will liaise with your loved one’s primary carer, such as a GP or district nurse, to confirm your request and gather the necessary clinical information.

We will keep you informed throughout the process.  

Our aim is to make accessing our services as quick and straightforward as possible. 

You can complete the self-referral form online, or if you prefer, download it, print it out, and bring it directly to Nightingale House Hospice.

Please call us and ask to speak to a member of our Patient Flow Team on 01978 316806 if you have any questions. 

The Patient Flow Team are available between 9am and 4pm, Monday to Friday (excluding Bank Holidays). 

Self-Referral Form

N.B. Please provide as much detail as possible. If urgent advice is needed please contact 01978 316806 (Mon-Fri 9am-4pm) or 01978 316808 (Out of hours)

Has the patient consented to this referral being made?
Has the patient given consent to access their medical records and to speak with other healthcare professionals?

Patient Details

Address
Current location of Patient
Please state in ‘Other’ if patient lives alone and enter other location below:

Details about Referral

Please indicate which service(s) are required:
If this is an URGENT referral for admission, please call the numbers above once you have sent the form.

Confirmation Details

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