RNCH Grief Services Referral Form
Please complete this form in one sitting that is less than 30 mins. Use an up-to-date web browser (do not use Internet Explorer), and ensure no other MyChart sessions are open. After submitting, you should see a confirmation message stating, "Your Request has been submitted". If you do not see this message, the submission was unsuccessful. Please close your browser window and submit the form again.
About Roger Neilson Children's Hospice Grief Support Services
Roger Neilson Children's Hospice offers free grief services to families who have experienced a perinatal death or the death of a child, including support for siblings, parents, and grandparents. We also provide grief services to children and youth who have experienced the death of someone significant in their lives, and we support caregivers in helping young people navigate their grief.
The information on this referral form helps us confirm eligibility and match families with the most appropriate program. All details are kept confidential and used only to ensure the right support for your needs.
A confirmation email for the reception of the referral will be sent to you. Please contact Roger Neilson Children's Hospice Grief Team to confirm receipt of referral if you have not received a confirmation email within 2 business days.