Are you or someone under the age of 18 in need of grief support?

The HUUG program (Help Us Understand Grief) is available to young people during their time of need. Learn more HERE.

Complete this form for a Child/Youth that needs HUUG.

Once you hit the SUBMIT REFERRAL FORM button the form will be emailed to our secure and confidential email.You should receive a copy of the referral form to the email address you identified in the referee section. If you do not receive an email, please call 905-712-8119 ext: 230 to confirm your referral was received.

You can also make a referral by calling 905-712-8119 (messages can be left on ext. 241 which is our confidential voice mailbox).

Or you can download and print the form and submit it to us by fax at 905-712-4029 or by email: info@hearthousehospice.com.


Referral information


Children's Information





Family Information

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Other Adults




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If you're ready, please submit this form by clicking the button below: