HOSPIS MELAKA
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  • HOME
  • HISTORY
    • Affiliations
    • Vision & Mission
    • Management Council
  • SERVICES
  • ACTIVITIES
  • CONTACT US
    • FORMS
    • DONATE
    • ONLINE REFERRAL
    • ONLINE FEEDBACK
  • TESTIMONIES

Forms      

ONLINE VERSION
referral_form_2024.pdf
File Size: 79 kb
File Type: pdf
Download File

Any patient who has an advanced cancer and where cure is unlikely and/or undergoing maintenance treatment for disease control is eligible for referral to the Hospice At-Home Programme.  Please email the completed form to [email protected]

Grievance Form
Was there any issues you would like to raise that we should be made aware of? We take your concerns very seriously and we will strive to do better for all of our patients.
membership form
2025_membership_form_bm.docx.pdf
File Size: 107 kb
File Type: pdf
Download File

2025_membership_form_eng.pdf
File Size: 107 kb
File Type: pdf
Download File

If you would like to join us as members, you will be involved with activities run by the committee ranging from awareness programme, fundraising to advocacy events.
Please email the completed form to us if you are interested to be part of the team.

Feedback Form
Would you like to highlight any feedback to us regarding the services that you have recived? We do value your feedback for us to highlight the importance of this service for the public.

History

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Feedback Form
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