Referral Forms

Who Can Refer

Saint Catherine’s cares for people who are over 18-years-old with advanced progressive life limiting illness (Malignant or Non Malignant diagnosis) and accepts referrals from GPs, District Nurses, Specialist Nurses, Consultants and other healthcare professionals.

Saint Catherine’s seeks to provide high quality support to patients in all of its services, but in doing so must ensure that its resources are used appropriately. To try to achieve this each of the admitting services has procedures and criteria which will be applied to all patients referred to us. 


How To Refer

Referral guidelines and information about services can be found below. We ask that referrers read these guidelines carefully before contacting us as this helps make the referral process as smooth as possible.

A fully completed Referral Form is required for all referrals – if you are making an urgent referral please telephone the relevant department to discuss and then send a Referral Form at the earliest opportunity. Further information on our Referral Forms is below.

You can refer to the following services: 


You Can Refer To The Following Services

In-Patient Unit – Click here for Referral Form 

Hospice @Home – Click here for Referral Form  

CNS Palliative Neurology – Click here for Referral Form 

CNS Community Palliative Care – Click here for Referral Form 

Wellbeing Centre – Click here for Referral Form 

Consultant Clinic – Click here for Referral Form 

Lymphoedema Clinical Nurse Specialist Clinic – Click here for Referral Form 

Bereavement Support Service – Click here for Referral Form

Specialist Palliative Care Counselling – Click here for Referral Form 

For more information on referring see below: 


In-Patient Unit

Patients with terminal illness can be admitted to Saint Catherine’s for symptom control that cannot be managed by the current healthcare team, care in the last few days of life,  and short term respite care when the patient is stable but there is increased carer strain.

Referrals for admission to the In-Patient Unit should be made to the Bed Manager/Senior Nurse acting as Bed Manager on a Referral Form and faxed to 01723 506113. For urgent referrals please telephone to discuss with the Bed Manager on 01723 351421.

Any clarification of need can be discussed with the Specialist Palliative Care Consultants.

The Bed Manager will liaise with the referrer when a bed is available.

All patients must be referred for admission with the agreement of their GP or Consultant.

Patients referred from hospital should be assessed by a member of the hospital specialist palliative care team, if available. The hospital notes should accompany the patient together with relevant nursing and medical documentation.

Find the In-Patient Unit Referral Form here.


Hospice at Home

Providing care and support in the patients home in the last stages of life. (Patients that are registered with Scarborough and Filey GPs only at present). Hospice at Home is a collaboration between Saint Catherine’s and Marie Curie to provide a 24 hour service.

The Hospice at Home Referral Form is here. Please fax to 01723 506113. For urgent referrals please telephone to discuss with the Hospice @ Home Team on 01723 351421


CNS Palliative Neurology

Criteria for referral

Patients and carers requiring help and support for advanced neurological disease which is unstable or rapidly deteriorating; MND from diagnosis; complex symptoms – physical, cognitive, psychological; repeated crisis events or infections; help and support with future health care planning

The CNS Palliative Neurology Referral Form is here. Please fax to 01723 506113. For urgent referrals please telephone to discuss with the CNS for Palliative Neurology on 01723 351421


Wellbeing Centre

Provides assessment, support and advice by the hospice multi disciplinary team in a pleasant and sociable environment.

The Wellbeing Centre Referral Form is here. Please fax to 01723 506113. For urgent referrals please telephone to discuss with the Wellbeing Centre Team on 01723 351421

For guidlines on who can be referred to the Wellbeing Centre at Saint Catherine’s, please click here.


Consultant Clinic

Consultation with a Specialist Palliative Care Consultant as an Out patient.

The Consultant Clinic Referral Form is here. Please fax to 01723 506113. For urgent referrals please telephone to discuss with the Medical Secretaries  on 01723 351421


Lymphoedema Clinical Nurse Specialist Clinic

Criteria for Referral

The service is for patients with lymphoedema which is secondary to malignant disease and patients with lymphoedema which is secondary to the treatment of malignant disease (this may develop months/years after the disease has been successfully treated)’.

The Lymphoedema Referral form is here and send to Lymphoedema service at Saint Catherine’s. If you wish to discuss a potential referral please contact the Lymphoedema Nurse Specialist on 01723 351421


Palcall – Out of Hours Telephone Helpline

Telephone support and advice from experienced Palliative Care Nurses to:

patients, healthcare professionals involved in their care and family and friends that the patient has given consent to call on their behalf.

For Palcall please print and complete the 3 Palcall registration forms Palcall Registration,  Named Caller Form and Data Protection consent form. Please print BOTH forms and fax to 01723 506113


Bereavement Support Service

Our counsellors and supporters are available to support bereaved relatives, friends and carers of Saint Catherine’s patients find ways of coping with their grief.

Palliative Care Counselling/Bereavement Support Referral Form


Specialist Palliative Care Counselling

Specialist Palliative Care Counselling to support Saint Catherine’s patients, relatives and carers, at any point during the time from a patient’s diagnosis through to the end of life. The service is provided by professional Counsellors and Psychotherapists.

Specialist Palliative Care Counselling/Bereavement Support Referral Form


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