How we help
Referral Forms
If you or someone you know is in need of help from Hospice Mississauga, please select and complete the appropriate referral.
Please provide as much information as you are able.
Once you click the SUBMIT button, the form will be sent to our secure and confidential email. You will receive a copy of the referral form at the email address provided in the referee section. If you do not receive the email, please call 905-712-8119 ext. 224 to confirm your referral was received.
Or you can download and print the form and submit it to us by fax at 289-724-0620 or by email: intake@hospicemississauga.ca
Hospice Referral
For anyone (regardless of age) who is diagnosed with a life limiting illness.
HUUG Bereavement Referral
For children and youth, under the age of 18, coping with the loss of a significant person in their life
HUUG Palliative Referral
For children and youth under the age of 18, who have a significant person in their life diagnosed with a life limiting illness