Caring is at the heart of everything we do.

Patient Referrals

Adult Hospice Referrals

Who can refer a patient?

The referrer must be a clinical professional who has assessed the patient and main carer(s) and has knowledge of the disease, symptoms, treatments, likely prognosis and the patient’s preferred place of care.

If the referrer is someone other than the person’s GP, they are required to notify the GP that a referral has been made to the specialist palliative care team.

Referral Criteria

The referrer must be satisfied that the person they are referring has an advanced and progressing life limiting illness with:

  • Unresolved complex physical, emotional, social or spiritual symptoms despite previous interventions; AND/OR
  • Patient/carer is in need of specialist end of life support including terminal care and bereavement services; AND/OR
  • A need for specialist palliative rehabilitation with clear functional goals; AND/OR
  • A need for a proposed period of respite provided by specialist palliative care in the case of emergency crisis situations, as per local specialist palliative care provider policy


See below for the Referral Guidance and Services Directory. Please review these guidelines before completing the Referral Form.

Patient Referrals

See below for the Referral Form *please note form is relevant for adult patient referrals only. Submit complete forms to Northern Ireland Hospice by email, post or fax.


Post to:

Referrals Department

Jennymount Business Park

Block 3 North Derby Street


BT15 3HN

Fax: 028 9074 5421

Patient Referral Form for Referrers »
Referral Guidance and Services Directory for Referrers »