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 confirming receipt of the referral. 

We usually review referrals every two weeks 

Once we have reviewed the form, if we are able to offer support then one of our Service Coordinators will contact the woman referred directly to discuss her support needs. 

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

Please ensure that the woman you are referring knows we will contact her directly if we are able to support her, so that she feels prepared and willing to speak to the Service Coordinator when they contact her. 

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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