Macmillan Referral

Self-referral

This form is for outside organisations only. If you are affected by cancer – as a patient, carer, or family member – you can self-refer for Macmillan services by phone or email directly. Call 020 8440 4227 or email infomacmillan@barnetcab.org.uk. We will respond within three working days.

Submitting this form

Please note that this form will only allow you to submit if the case falls within our remit. If the case does not fall into our remit, please phone Macmillan 0808 808 00 00 or visit the website here.

Macmillan referral
Has the client given consent to this referral?
Does the client live, work, study, or receive treatment in one of the following locations?

Please confirm which of the following apply. In Enfield, Barnet, Islington and/or Haringey, the client...
The client is a
Which of the following best describes the patient's situation? (Choose one)
Was the patient's last chemotherapy, radiotherapy, or surgery in the last 18 months?

About you, the referrer

Referrer's name
Referrer's name
First
Last
Organisation

Reason for Referral

What is the reason for referral?
Is the client SR1-eligible?

Maximum file size: 2.1MB

Client Information

Name
Name
First
Last
Address
Address
City
County
Postcode
Can we leave a voicemail?
Can we send a text?
Can we send an email?
I confirm the above client has given permission for this referral to be made and for Citizens Advice to store and process sensitive personal information about them

Please note that this form will only allow you to submit if the case falls within our remit. If the case does not fall into our remit, please phone Macmillan 0808 808 00 00 or visit the website here.