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

You can either fill out the form at the bottom of this webpage or download and complete the form before emailing it using an account to

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.

Make a referral

Step 1 of 7

  • All referrals MUST be accompanied by recent clinically relevant correspondence
  • The patient has a diagnosis of advanced life limiting illness and:
    • Symptom control or other complex problems, which are escalating or are unable to be managed by the current clinical team. These symptoms may be physical, psychological, spiritual, social, or family/carer orientated issues.
    • Has capacity & has consented to referral OR lacks capacity for this decision but it is agreed to be in their best interests