HCP Referral

HCP Referral Form

Please fill out the form below to refer your patient.

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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.

Patient & Family Story

Michelle’s Story

My son Sean received his second cancer diagnosis just before Easter. He was treated in Castlebar Hospital and was then transferred to Galway. We live two and a half hours from Galway, it’s just me and Sean at home and I don’t drive. I found it very difficult to ask people to keep bringing me […]

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Mary’s Story

At the end of last year, when my partner Paul was 50, he started to feel unwell. He was referred to University Hospital Galway where he received a diagnosis of lung cancer. Paul was given a combined treatment plan of 6 weeks Radiotherapy and 4 weeks of Chemotherapy. For the first week of his treatment,

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Mariéad’s Story

Joe and I have been married for 40 years. Joe has always been very active in our community of Dunmanway, West Cork and even more so since his recent retirement. In April Joe was diagnosed with Myeloma, a hard knock for our family. Joe initially had 16 weeks chemotherapy treatment in Cork, followed by surgery

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