Make a referral - Birmingham St Mary's Hospice

Referrals to all of our services can now be done using just one form.

If you are a patient wishing to be referred, please speak to your doctor, nurse or consultant who will be able to refer you to Birmingham St Mary’s. All referrals must be submitted by a healthcare professional. This is to ensure that we work in partnership with the other professionals involved in your care.

Fill out the form to refer:

Community CNS Clinics
Medical Outpatients Appointment
Day Hospice Services
Therapeutic Programme (12-week programme)
Breathlessness Programme (5-week programme)
Welcome Group (support group)
Community Palliative Care Services
CNS Support
Hospice at Home
Inpatient Unit

Please download and complete the form before emailing it using an nhs.net account to stmaryshospicereferrals@nhs.net.

Download referral form

Referrals can still be faxed but please be aware that the Hospice will be phasing out fax communication in the near future.

Hospice at Home secure fax number – 0121 471 2079
CNS Team secure fax number – 0121 472 4159

If you have any queries or would like any advice regarding new referrals, our Triage Nurse, Rachel Shuttleworth, is available Monday to Friday (8.00am to 4.00pm) on 07726 580153.

For urgent referrals, please ring Rachel using the number above between Monday and Friday, and for Saturday and Sunday, call our CNS Team on 0121 752 8798.

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Your personal data will be used to process your order, support your experience throughout this website, and for other purposes described in our privacy policy.

Access to and use of this site is provided by Birmingham St Mary’s Hospice subject to the following Terms and Conditions:

1. Your use of this site constitutes acceptance of these Terms and Conditions, which take effect on the date of your first use of the site.

2. Birmingham St Mary’s Hospice reserves the right to change the Terms and Conditions at any time by posting changes online. Your continued use of the site after changes are posted constitutes acceptance of this agreement as modified by the posted changes.

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4.1 Any organisation wishing to set up a link to this site must request this by contacting info@birminghamhospice.org.uk

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5.1 The Birmingham St Mary’s Hospice logo is the trademark of Birmingham St Mary’s Hospice.

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6.1 The photographs used within this site to illustrate Birmingham St Mary’s Hospice work may be posed by models and may or may not depict actual situations.

7. You agree to use this site only for lawful purposes, and in a manner which does not infringe the rights of, or restrict, or inhibit the use and enjoyment of this site by any third party. Such restriction and inhibition includes, without limitation, conduct which is unlawful or which may harass or cause distress or inconvenience to any person and the transmission of obscene or offensive material or disruption of normal flow of dialogue within this site.

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9. Birmingham St Mary’s Hospice does not accept liability for any damages, including, without limitation, indirect or consequential damages, or loss of profits, or any damages whatsoever arising out of or in connection with the use or loss of use of this site.

10. Birmingham St Mary’s Hospice does not warrant that the functions contained in the material included in this site will be uninterrupted or error-free, that defects will be corrected, or that this site or the server that makes it available are free of viruses or bugs or represents the full functionality, accuracy or reliability of the materials.

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Users contacting this website and/or its owners do so at their own discretion and provide any such personal details requested at their own risk. Your personal information is kept private and stored securely until a time it is no longer required or has no use, as detailed in the Data Protection Act 1998. Every effort has been made to ensure a safe and secure form to email submission process but we advise users using such form to email processes that they do so at their own risk.

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Information we may collect from you

Birmingham St Mary’s Hospice may collect and process the following data about you:

• information that you provide by filling in forms on the website www.birminghamhospice.org.uk This includes information provided at the time of signing up to participate in Fundraising and other events organised by Birmingham St Mary’s Hospice, becoming a member of the website and subscribing to any of Birmingham St Mary’s Hospice’s electronic or paper marketing and news updates.
Birmingham St Mary’s Hospice may also ask you for information if you report a problem with the website:
• any correspondence you send to Birmingham St Mary’s Hospice;
• details of any donations or job applications that you make;
• Birmingham St Mary’s Hospice may also ask you to complete surveys used for research purposes, although you do not have to respond to them;
• details of your visits to this website and the resources that you access;
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Birmingham St Mary’s Hospice may collect information about your computer, including where available your IP address, operating system and browser type, for system administration and to report aggregate information to our advertisers. This is statistical data about Birmingham St Mary’s Hospice’s users’ browsing actions and patterns, and does not identify any individual.

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Birmingham St Mary’s Hospice website uses cookies for collecting user information; it does not collect any information about you except that required for system administration of the web site. These cookies are pieces of data created when you visit a site, and contain a unique, anonymous number. They are stored in the cookie directory of your hard drive, and do not expire at the end of your session.

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17.1 You agree that any costs or risks that arise out of your fundraising activities are your responsibility, including liabilities for injury or loss which may occur to you, your helpers or guests.

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17.6 You consent that photographs taken during your fundraising activity may be used to publicise the work of Birmingham St Mary’s Hospice generally.
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