Before completing this form we recommend that you read our Guidance for referrers.
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 you own contact information first and then add your referral's details in the following sections.
After submitting a referral form to Birth Companions, you will receive an email from our Administration & 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 Services Coordinators.
Please explain this in advance to your referral 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.
Given the current situation, we have taken the difficult decision not to offer birth support or group based support at this time. However we are continuing to take referrals and will be adapting and developing our support model to enable us to continue to work with perinatal women during these challenging circumstances.
If you have any problems submitting your form please email us.