Specialist Perinatal Service and Maternal Loss Psychology Service Referral form

Use this form to refer into the Specialist Perinatal Service or Maternal Loss Psychology Service.

Please be aware that these services are not self-referral. Healthcare professionals should refer. 

The Perinatal and Maternal Loss referral form was updated on Thursday 29 May 2025. The process for submitting referrals remains the same, using the link on this page. The referral form will remain largely unchanged. If you have saved or bookmarked the current referral link, please update it from 29 May 2025. For any issues with referrals around this time, contact the Perinatal team at 03000 270480 or Perinatal@nhft.nhs.uk for support.

Specialist Perinatal Service and Maternal Loss Psychology Service referral form