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

Consent*
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 MARTINA

Martina Hickey

Martina Hickey has worked at Cancer Care West since 2007. She completed her RGN training at the Whittington Hospital, London, and her Higher Diploma in Oncology at NUI Galway in 2005. She has worked at Laurence Hospital, Bronxville, New York and the SAOLTA University Healthcare Group in the Respiratory Unit at Merlin Park. She has a special interest in lung cancer having worked in this area both in Ireland and abroad.

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