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How We Can Help
What we can do to support you

We provide care and support for people with end of life care

Day Services

Hospice At Home

Bereavement Support

Heart Failure / COPD Support

Gold Standards

Help For Patients

Help For Families

Professionals Referrals
How You Can Help Us
What you can do to support us

Supporting our work can be easy. We rely on the generosity of the people of Corby to ensure our service can continue

Volunteer

Donate

Fundraising

Corporate Sponsor

Events

Impact
About Us
How Lakelands works

Supporting our work can be easy. We rely on the generosity of the people of Corby to ensure our service can continue

About Us

How We Are Funded

Our History

Meet The Team

Personal Stories

Donate

Online Referrals

Please use the below forms to refer a patient to our services online. This is the quickest method for us to begin to support your patient. If you have any questions or issues please contact us on (01536) 747859 or email at info@lakelandshospice.org.uk.

Daycare Referral

Hospice Day Care Form

If you would like to refer a patient into our Day Care Hospice, then please either complete the form below, download our services leaflet or give us a call (01536) 747859 Mon-Fri 9-5pm ( Excluding Bank Holidays ) We look forward to hearing from you.

Daycare Referral

Patient First Name

Patient Middle/ Last Name

Patient Date Of Birth

Patient Address

Address Line 1

Address Line 2

Post Code

Patient contact Number

Nurse Involvement

Yes

No

Nurse Name/ Contact

Heart Failure / COPD Referral

Heart Failure / COPD

If you would like to refer a patient into our Day Care Hospice, then please either complete the form below, download our services leaflet or give us a call (01536) 747859 Mon-Fri 9-5pm ( Excluding Bank Holidays ) We look forward to hearing from you.

Daycare Referral

Patient First Name

Patient Middle/ Last Name

Patient Date Of Birth

Patient Address

Address Line 1

Address Line 2

Post Code

Patient contact Number

Nurse Involvement

Yes

No

Nurse Name/ Contact

Hospice at Home Referral

Hospice Day Care Form

If you would like to refer a patient into our Day Care Hospice, then please either complete the form below, download our services leaflet or give us a call (01536) 747859 Mon-Fri 9-5pm ( Excluding Bank Holidays ) We look forward to hearing from you.

Daycare Referral

Patient First Name

Patient Middle/ Last Name

Patient Date Of Birth

Patient Address

Address Line 1

Address Line 2

Post Code

Patient contact Number

Nurse Involvement

Yes

No

Nurse Name/ Contact

Bereavement Service Referral

Hospice Day Care Form

If you would like to refer a patient into our Day Care Hospice, then please either complete the form below, download our services leaflet or give us a call (01536) 747859 Mon-Fri 9-5pm ( Excluding Bank Holidays ) We look forward to hearing from you.

Daycare Referral

Patient First Name

Patient Middle/ Last Name

Patient Date Of Birth

Patient Address

Address Line 1

Address Line 2

Post Code

Patient contact Number

Nurse Involvement

Yes

No

Nurse Name/ Contact

Other / Advice

Information And Advice

If you would like more advice or information on the services we provide and facilities we have. Please get in touch with us below and we will get back to you as soon as we can.

Daycare Referral

Patient First Name

Patient Middle/ Last Name

Patient Date Of Birth

Patient Address

Address Line 1

Address Line 2

Post Code

Patient contact Number

Nurse Involvement

Yes

No

Nurse Name/ Contact

Telephone

Email

enquiries@lakelandshospice.org.uk

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Contact
About

Find Us

Lakelands Hospice
Butland Road
Oakley Vale
Corby
Northants
NN18 8LX

Charity Number 1062120

Company Number 3325051