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.

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Why Donate

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Helping cancer patients and their families

Cancer Care West works with cancer patients and their families to provide practical and emotional supports at a time when they need it most. It costs over €1.5m each year to provide our services and 69% of these funds come from the public through fundraising and donations. Why not Donate now

 

No donation is too small

A small donation of €5 per month can make a big difference to those who need our services. Find out about becoming a regular donor and how your regular donations can help us. Make a Monthly Donation here

 

How your donation helps

In 2015 more than 2,500 people from all over the west and northwest of Ireland availed of our services.

We had 7,112 visits to our Galway Cancer Support Centre provided 8,568 bed nights to cancer patients and their family members at Inis Aoibhinn.

We provide these services free of charge to those who need them. Your support helps us to make this possible. Why not make a donation now

 

Keeping admin costs low

Cancer Care West relies on income raised through fundraising and donations to support our services. Our income and spending is set out each year in our Annual Report and Accounts which are independently audited. 79 cent out of every euro raised is spent directly on our work with cancer patients and their loved ones.

 

 

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