HCP Referral

HCP Referral Form

Please fill out the form below to refer your patient.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Patient's Details

Patient’s Name*
Patient’s Date of Birth

Referrer’s Details

Please note: We are not an emergency service. If you need emergency input regarding this referral please link with the patient’s GP or contact Emergency Services as appropriate.

HEADSHOT LAURENA

Laurena Mitchell

Laurena worked for many years as a Senior Executive Officer in Galway City Council and holds vast experience in Housing, Finance and Planning services. In the various roles, Laurena has worked closely and built strong relationships with other service providers (both statutory and voluntary bodies). This has given her a great insight and understanding into the kind of challenges faced by those affected by cancer and provides her with the experience, expertise and skill set to assist, support and advocate on their behalf.

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