ARE YOU LOOKING FOR GRIEF SUPPORT FOR A FAMILY, CHILD, YOUTH OR YOURSELF?

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 Referral Information 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 Source



Children's Information





School Information


Family Information

Guardian/Custodian Information


Other Adults




More Details

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

NOTE: Do not close this window/tab or refresh until you see the message that your request has been submitted.