HCP Referral

HCP Referral Form

Please fill out the form below to refer your patient.

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Patient's Details

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Patient’s Contact Number*

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Referrer’s Details

Referrer’s Name*

Referrer’s Position/Profession*

Referrer’s Contact Number*

Referrer’s Email Address

Reason for Referral*

Consent*

Patient’s Consent Received

I confirm that these details are correct and that the patient has consented to this referral and to receiving contact from Cancer Care West.

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.

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1 event found.

Group Meeting

Name: Partner’s Support Group
Start: 2026-01-16T14:00:00+00:00
End: 2026-01-16T15:30:00+00:00

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January 2026

Fri 16

January 16, 2026 @ 2:00 pm - 3:30 pm Partner’s Support Group

Partner’s Support Group

Group Meeting

A peer support group for partners of those diagnosed with cancer. The group invites partners to reflect on the impact cancer is having on them and aims to be a supportive and safe place for partners to share their experiences with others in a similar situation. The group meets every 2nd month on a Friday […]

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Inis Aoibhinn
091 545 000
[email protected]

Galway Cancer Support Centre
091 540 040
[email protected]

Donegal Cancer Support Centre
074 960 1901
[email protected]

Charity Registered Number: 20030438
CHY Number: 11260 AOD: 150525

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