Marie Curie ACP referral form

Marie Curie ACP referral form


Please complete the form (click the link below to open) to refer a person to the Marie Curie ‘Talk About’ project.

Once the form is complete, please send it to: lat.mccompanionservice@nhs.net

Once received Marie Curie will contact the person, explain more about the service, and answer any questions, should they wish to proceed and will arrange an Advance Care Plan to be completed by a Marie Curie Companion.

If you have any questions or to make the referral over the phone contact us on 0800 3047412.