Community Nurses, GP's, Palliative Care CNSs and Adult Care Services can make referrals and in some cases patients can self-refer. All our services referral forms are listed below. Please make sure you use the right one for the right service. If in any doubt, please contact us.


Specialist Palliative Care Services Referral Form

This form can be used for referrals to all Specialist Palliative Care Services in South West Hertfordshire and is for Heathcare Professionals use only.

What are the referral Criteria?

  • The patient must agree to the referral
  • The patient's GP should agree to the referral
  • The patient should be known to a Community Nurse/Community Palliative CNS
  • The patient must be over age 18 and resident in South West Hertfordshire
  • The patient should be in the terminal phase of their illness and have complex needs requiring specialist palliative care
  • The carers need increased support

Download Forms 

  • Referral form as PDF

Counselling Service referral form

This form can be used for referrals to Counselling services at Peace Hospice Care and is for Heathcare Professionals use only.
You can self-refer by calling the Bereavement Office on 01923 229595.

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Herts Neighbours Service referral form 

This form can be used for referrals to the Herts Neighbours Project only, throughout Watford and West Herts and is for patients to self-refer as well as Heath Care Professionals.

What are the referral Criteria?

A patient may qualify if they...
  • live in the West Herts area
  • have a life-limiting illness
  • live on their own or have a carer
  • live in their own home or in a care home

Download Forms