Self-referral enquiry We're here for you All you need to do is complete the form below or call The Hawthorne Centre on 01462 679540 (Option 2) and say you’d like to refer yourself to our service, leaving your name and telephone number. One of our team will call you back within 5 working days to discuss your situation and needs. With your consent, we will then register you as a patient and start working on a plan of how to support you (and your family). Same day call backs are not always possible but we endeavour to speak to you as soon as possible. Leave this field blank Mr/Mrs/Miss/Ms/Other First Name Last Name Address 1 Address 2 Town Post Code Phone Email address NHS Number (if known) Please select one of the below: ---I am the patientI am a family member/carerOther How do you think the Hospice/Day Services can help you? Submit