Get Referred

How do I get referred?

Access to Hospice services as per the criteria in our mission statement can be done as follows:

  • Referral by a private medical practitioner
  • Referral by a clinic or provincial hospital
  • Family or self referral with a complete medical history
  • Palliative care patients will be contacted within 24 hours of referral. Chronic care patients will be contacted within a week of referral. In instances where the patient does not meet our referral criteria, we will suggest and facilitate alternative service providers.

Referral Form

Please download the Form here.
If you need to download a PDF reader you can get it here.

Once you have downloaded the form and completed it, please email it to

If you have any questions, please contact Sr Hilary Grey on (044) 384 0593 or email her on . The sister will contact you regarding problems and any possible medication alterations

Please note: the Medical form needs to be signed.