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Hospice services professional referral form

Last year of life services referral

This referral form is used as a single point of access to services for patients within the last year of their life and/or complex specialist palliative care needs. This form needs only to be submitted once, and will encompass all services listed below. Please do not submit any additional referrals for this patient to other services that are included on this form. If your referral is urgent you need to call SinglePoint on 01206 890 360 to mark it as urgent.

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Last updated: 22nd November 2021

Upon successful completion of this form you will receive a referral number and confirmation email. If you do not receive a referral number please call us on 01206 890 360 as your referral will not have come through to us.

Referral source

(If you mark the referral as non-urgent it will be dealt with the next working day.)
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