Make an online referral

How to refer to us

The best way to refer somebody to The Shakespeare Hospice is by completing our online referral form. The form can be completed by anyone, whether you’re a patient, family member / friend, or a healthcare professional.

Other ways to make a referral

If you are a member of the public and wish to make a referral, please call our main Hospice number on 01789 266852 or alternatively email any enquiries to enquiries@theshakespearehospice.org.uk.

If you are a professional wishing to make a referral on behalf of a patient, please call our Single Point of Access on 01789 333139, for a quick response, as we acknowledge the potential time pressures that many are faced with.

This line is manned seven days a week.

Have a question?

If you have a question, please feel free to contact us.

Online referral form

The online referral form is split into two steps. On occasion, we may require additional information and will contact the referrer directly for this, using the details entered below.

Fields marked with * are required.

Step

Referral type

Which type of referral are you making?

This is required

Referrer contact details

As the referrer, please let us know the best contact details to reach you.

This is required
This is required
This is required
This is required

Services

Which service is required?

Back to step 1

Who will be using the services?

Please let us the know the details of the person who may benefit from our services.

This is required
This is required
This is required
This is required
This is required
This is required
This is required
This is required
This is required
This is required
This is required
This is required
This is required

We need to collect your personal information to respond to your enquiry. For further details on how your personal information is used, please view our Privacy Policy.

Back to step 1