Hampshire Macmillan Citizens Advice Service Direct Referral Form

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Please use this form to make a direct referral to one of our caseworkers in the Hampshire Macmillan Citizens Advice Service.
A receipt will be sent to you on submission of this form.

Our service is for people affected by cancer who are resident in or being treated in Hampshire, including Southampton, Portsmouth and the Isle of Wight. This includes patients, families and carers.
We aim to respond to referrals within three working days, but during this busy time when demand is high, this could be up to five working days.

If you need help with the form or want to speak to one of our caseworkers, please call 0344 847 7727. Our lines are open Mon-Friday 9am - 4pm.
You can also contact our team email: macmillan.cahampshire@cabnet.org.uk
DS1500s can also be sent to this email as we are unable to attach them to this form.

Our privacy policy can be found here:
https://www.citizensadvice.org.uk/about-us/citizens-advice-privacy-policy/when-you-get-advice-from-an-adviser/

Your name, outreach location, contact email/telephone details

Your relationship to the person referred

palliative care social worker

The client is aware of and has agreed to this referral and has agreed to the storing and processing of personal and special category data *

Yes

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