Al-Amal Referral

Professionals, please complete and submit the form below with the necessary details to make a referral.

Medical Guidance

We are available to assist patients in understanding their medical care, particularly in relation to faith. If your patient has questions or requires additional guidance, our palliative care consultant is ready to provide the necessary support. Please refer your patient by completing the form below with any relevant details, and we will ensure they receive the information and guidance they need to make informed decisions about their care.

Emotional & Spiritual Support

We offer emotional and spiritual support over the phone for both patients and their families. If you believe this support would be beneficial, please submit the referral form below with the relevant details. A member of our team will reach out to arrange a call at the earliest opportunity.

Client Name

First Name

Last Name

Phone

Message

Referrer's Name

Referrer's Contact

Referrer's Organization

Checkbox

I understand that the information will be kept in accordance with the Data Protection Act 2018 and will only be retained for the purpose of Al-Amal services and will not be disclosed to any third party without consent.