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Welcome to the Rosie's Trust Referral page.

Please note we can only assist (dependant on resources) individuals who are terminally ill, the elderly with disability and /or people undergoing cancer treatment.

On receipt of referral we will endeavour to contact the referrer within 7 working days. If the referral is more urgent than this please advise.

Privacy notice: All personal information you provide on this form will be handled in accordance with the General Data Protection Regulation (GDPR). It will be held securely and will be used only to progress this referral. Rosie's Trust will not pass on your information to a third policy under any circumstances.

Please tick the box below, then press Continue:

Next of Kin

Name:

Relationship:

Phone number:

Address:

Postcode:

Additional Residents

Key Workers

Animal Details

Details of animals involved e.g. breed, age, temperament or any details you feel we should be aware of:

Please advise if this is a recent problem with the care or ongoing. What are the main requirements at this stage?

Thank you!

Thank you for your referral!
A Rosie's Trust team member will review the details and be in touch soon. 

Regards,
The Rosie's Trust team