Knysna Hospice : Referral Form

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 or fax it to (044) 384 0456

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.