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.

Make a real difference in someone's life....

Why Choose Us?

The demand for our services is growing each year.  We want to make sure that everyone who needs us has access to our supports and that no one goes through a cancer experience alone.  But we need your help to achieve this.

1. We don't charge for any of the services we provide

Ensuring that everyone has access to all of our services is of huge importance to us at Cancer Care West, and that is why we don't charge for any of our services - so whether you are dropping in to one of our Cancer Support Centres for a cup of tea or staying at Inis Aoibhinn for 7 weeks - there is no cost to you or your family.

2. How we use the funds you raise

Your money will help us to provide a variety of services that help make sure no one has to go through a cancer experience alone. We rely on fundraisers for 69% of our funding support so you really are very important.

You can also contact us for an informal talk about any fundraising or volunteering support you might be able to give.

3. We’re careful with your money

With more and more people using our services each year, the need for our work is constantly growing.

Thanks to our loyal and committed fundraisers and donors, over 69% of our income came from voluntary giving and fundraising in 2015, so we take care to manage our money wisely. Each year we produce an Annual Report and Accounts, which are independently audited.

4. Be part of the Cancer Care West team

Now, more than ever, we need people like you to join our team and get involved. Whether you hold a table quiz, take part in one of our sporting events, make a donation, or give your time and energy, you can make a huge difference for people affected by cancer. Read more about our Fundraising and Events.

Scroll to Top