• All referrals must be accompanied by recent clinically relevant correspondence

    Criteria for referral - 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. - complex social needs resulting from their illness or whose families show exceptional emotional distress - has capacity & has consented to referral OR lacks capacity for this decision but it is agreed to be in their best interests.
  • Patient Details

    Compton Care will only share details with necessary healthcare professionals, this might include GPs, District Nurses, hospitals, social work team etc.
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  • Ethnicity

    Please select one option from the list below
  • Services Required

  • Your Details

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  • Next of Kin or Carer

  • District Nurse

  • General Practitioner

  • Care Package

  • Communication

  • Further Details - if appropriate

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  • Diagnosis

  • Advance Care Planning (formally or informally)

  • Urgency of Referral

    Referrals are processed within our working hours of Monday - Friday from 8am - 5pm. Urgent referrals will be processed on a daily basis. For out of hours queries, please contact 0300 323 0250.
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    If this exceeds four days, an updated referral will be required including any changes to medications or symptom control.
  • Insight

  • If this form is not fully completed, this will delay referral to our services. Please ensure patients are aware information will be held on computer according to the GDPR.

Speak to Compton in person, call us on 0300 323 0250