Wellbeing Hub Self-Referral Form


If you feel that the Wellbeing Hub may benefit you or your carer please complete the information below. 

You will then be contacted by a member of the Wellbeing Hub team to discuss your needs and how the service might be able to help you. 

If you are uncertain as to whether the Wellbeing Hub is appropriate for your needs please call us on 01204 663066. 

About You
Contact details
What is your preferred contact number?
Medical Conditions
The personal information you have provided to Bolton Hospice will be processed in accordance with current UK data protection legislation and our privacy policy which is available to view at www.boltonhospice.org.uk/privacy-policy or upon request.

The main purpose for which we process your personal information is to administer your self referral but for further information please see our privacy policy. Your information will be held securely.