This form is for over 18s only. We offer bereavement support to all adults in north and mid Essex, no hospice connection is needed. To refer yourself for support please complete the form below - it should take around 10-15 minutes. Fields marked * are mandatory and must be completed before you can submit the form. When you correctly submit your referral a reference number will be given to you on screen. If you do not see a reference number once you have submitted your referral please check you have completed all of the mandatory fields. If you experience any technical issues please contact the bereavement team on 01206 984 274.
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When you make a donation to St Helena Hospice, we are charged transactional fees by other companies, including fees for processing payments made to us, looking up addresses and validating bank account details.
We are very grateful to our donors who offer to offset some of these fees with a minor addition to their total amount. This is however completely optional and we are very grateful for your support whether or not you choose to contribute to processing fees.Close
We are able to claim an extra 25p on every £1 on your donation amount for no extra cost to you, as long as you are a UK tax payer; have paid enough income tax or capital gains tax in that tax year; and are donating your own money. For more information about Gift Aid, please visit www.gov.ukClose