Self-Referral

If you would like to refer yourself, or gain information for a relative or partner, please download and complete this Self-Referral form in block capitals and return by email to mycarecoordinationteam@nhs.net.

Criteria: Adult patients who have a diagnosis of a progressive life-limiting disease and are in the palliative stage of their illness. They will be symptomatic with difficult or complex psychological, social or spiritual issues.

Self referral form

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