Make a referral

We're here to help you

Children and families come to CHAS for lots of reasons. Some may need support for a short time while others may need support for many years.

We understand that it might be scary to hear that your child might need support from a hospice.

CHAS can offer you support at all critical stages, from diagnosis and learning your child is seriously ill, to helping your child live well, at end of life and through bereavement.

We can support you and your family when you need us most.

If you'd like to talk to us about a child's needs, please give us a call using either of the numbers below.

We'll answer all your questions and give you the support you need.

Rachel House: 01577 865 777 or Robin House: 01389 722 055.

Find out what happens when you make a referral

The details requested on this form are reviewed by a referral panel which helps us work out how to best help your child and family.

However, in more urgent situations, please phone us at:
Rachel House: 01577 865 777 or Robin House: 01389 722 055.

Ask to speak to one of the nursing or medical teams about an urgent referral. 

The information provided in the referral form below is delivered via a secure email address to ensure secure data transfer and is processed in compliance with the Data Protection Act 2018.

To help further, a knowledge of the following would be very useful:

Details of child
Gender *
Do you know which service you are making a referral for? *
Family information
Please include DOB next to name if possible.
Please include DOB next to name if possible.
Has the referral been discussed with the family (or with the child/young person, where appropriate)? *
Referrer details
Professional involvement

Please add the name of GP plus any other professional involved, e.g paediatrician, pharmacist, named person, lead social worker, community children's nurse / oncology outreach nurse / health visitor.

Add another professional?
Professional involvement - 2

Please add the name of GP plus any other professional involved, e.g paediatrician, pharmacist, named person, lead social worker, community children's nurse / oncology outreach nurse / health visitor.

Add another professional?
Professional involvement - 3

Please add the name of GP plus any other professional involved, e.g paediatrician, pharmacist, named person, lead social worker, community children's nurse / oncology outreach nurse / health visitor.

Consent