Referral forms

Potential patients must complete a referral form, either filled out by yourself or a health care professional who wishes to refer you to our hospice.

Please note that for self-referrals we will need to speak to a health care professional involved in your care to make sure we have all the relevant information needed.

Forms can be emailed to, or posted directly to us at 1 Crichel Mount Road, Lilliput, Poole, Dorset, BH14 8LT.

If you would like to speak to someone in more detail about referring yourself or someone to Lewis-Manning Hospice Care please contact a member of our team on 01202 708470 or email,

Get to know more about our important services

Please get in touch with us on 01202 708470 or email