Referral Form for Health Organisations

Model of Care

Is your patient eligible for Dove House services?

  • They must have a diagnosis of illness that is life threatening.

  • They do not need to have a terminal diagnosis.

  • They may be having curative treatment for their illness.(eg. surgery, chemotherapy, radiotherapy) and need support through this time.

Please complete the below form to refer your patient.

If you are a patient - please click here

All services are free of charge

What Services do we offer?

If you wish to speak to someone regarding accessing the service, please call 09 575 4555.

Health Organisation - Patient Referral Form

Ethnic Group

Thank you for submitting your referral.

One of our Dove House Team members will be in contact with you shortly.

If you require any further assistance, please email