Supporting Patients - Referral Form for Patients

Model of Care

How do I access Dove House services?

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

  • You do not need to have a terminal diagnosis.

  • If you are currently undergoing treatment for your illness such as surgery, chemotherapy, radiotherapy, you may need support through this time.

Do I need a referral from my doctor?

  • No, you can refer yourself, or you can be referred by a family member or friend, your GP or other health care provider who is known to you and has your permission.

If you wish to access Dove House services, please complete the below form:

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.


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