Before completing this form we recommend that you read through our Guidelines for Referrers booklet:

Guidelines for Referrers - Support for pregnant women and new mothers with involvement from the Criminal Justice System in the community

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, we can only accept Community perinatal support - Criminal Justice referrals for women being supported by Advance in one of the following regions: London, Essex, Hampshire, Hertfordshire, Kent, and Thames Valley.

If you wish to refer a woman to any of our other community services, please go to our Community services referral form.

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

Referral form: Community Criminal Justice 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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