Carer or Bereaved

We are able to support anybody who lives in the North West Region who has been affected by a diagnosis of cancer or other life-limiting condition. All clients must have a reasonable level of independence and cognitive awareness to engage with the psychological support we offer. Once we have received a referral form, we aim to make contact within 7 days.

Self-Referral Form (Carer and Bereaved)
Please tell us how you heard about Beechwood *

Diversity Indicators

Section A

Email helps the charity to reduce paper and postage costs
Disability *
How can we contact you?
Have you attended Beechwood before? *
Full Mobility *
Limited Mobility *
Please tick the services you are interested in:
We offer a very limited transport service to people who live in Stockport.
N.B. We cannot guarantee this will be possible as it is on a volunteer driver basis.
Emergency Contact Details

SECTION B (to be completed if you are currently caring for an ill relative)

SECTION C (to be completed if you have recently been bereaved)

Beechwood Stories