Before completing this form we recommend that you read our Guidance for Referrers booklet.

When filling in this form please ensure that the information you provide is accurate. 

  • The more detail we have about why you are making the referral, the quicker we will be able to follow up on your request for support. 
  • We would recommend that you complete this form whilst you are with the woman you are referring.
  • Please add your own contact information first and then add the details of the woman you are referring in the following sections. 

After submitting a referral form to Birth Companions, you will receive an email from our Administration and Information Officer, or your specific contact at Birth Companions, to confirm receipt of the referral. 

Thereafter, the woman referred can expect to be contacted directly by one of our Service Coordinators. 

Please explain this in advance to the woman you are referring, to help her to feel prepared and willing to speak to the Service Coordinator when they contact her. 

Our Service Coordinators are all female, will always introduce themselves by name and will say they are from Birth Companions. 

Please note that we are only able to offer support to women in the community in London.

If you have any problems submitting your form please email us.

If you wish to refer a woman supported by the Advance WrapAround service to our Community perinatal support - Criminal Justice service, please go to our Community perinatal support - Criminal Justice referral form.

Referral form: Community services


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Birth Companions is registered in England and Wales under charity number 1120934 at Dalton House, 60 Windsor Avenue, London SW19 2RR. We use cookies to improve your experience using this website.
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