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Potential patients must complete a referral form, either filled out by yourself or a health care professional who wishes to refer you to our hospice.

Please note that for self-referrals we will need to speak to a health care professional involved in your care to make sure we have all the relevant information needed.

Digital referral forms

Digital forms are the fastest way for us to process your referral. Complete the forms on our website today. Alternatively, discover our paper forms on the links below. 

Paper referral forms

Please print, fill in, and send to us via email or post. You can also bring the form in to our hospice at 56 Longfleet Road, Poole. 

To be referred to our Lymphoedema or Breathlessness service, please ask your healthcare professional.

If you would like to speak to someone in more detail about referring yourself or someone to Lewis-Manning Hospice Care please contact a member of our team on 01202 708470 or email, enquiries@lewis-manning.org.uk.

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