Wellbeing referral form

The Prince of Wales Hospice Wellbeing and Community Service

Our service is available to anyone who lives in Pontefract and the Five Town’s area of Wakefield District, who has a progressive life shortening illness, their carers and who is over the age of 18.

If you or your carer are interested in accessing our wellbeing service, you can refer yourself by  filling  in this form or calling  01977781451. A member of our team will contact you to discuss which group or session you would be interested in joining and how we can best support you. We try to reply within 72 hours of receiving your referrals.

Please, tick which sessions you are interested in:

Are you referring for yourself? :


If you do not have consent from the person we cannot process the referral and  we ask that the person who wants to access the service makes the referral ether by filling in this form or by calling 01977 781451. 

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