Make a Referral

A medical practitioner can make a referral to the Inpatient Unit or the hospice at home community services by completing the following pdf, and return as per instructions below –

Specialist Palliative Care Service Referral Form.pdf

Options for returning form:

email to:

Specialist Palliative Care Community Services:

Hospice In-Patient Unit Referrals:

  1. Only using Google Chrome Browser can you fill out the form online, then download and attach to the relevant email above.
  2. If you do not have Chrome Browser, download the PDF to your computer and using your PDF Editor (adobe or whichever) complete the form, save to your computer and email to: or
  3. Print off the form, complete and post to:
    Hospice at Home Referrals,
    Milford Care Centre,
    Hospice In Patient Unit Referrals,
    Milford Care Centre,
Please attach any relevant results, discharge letters, images etc. to your email

Thank you

More Information