* PLEASE SEE OUR REFERRAL GUIDELINES TO CLARIFY THE EXACT AREAS WE COVER.*
We retain the right to determine which of our services will be most suited to those referred. If you have any concerns about the referral process or the support for the individual, please contact firstname.lastname@example.org
We can accept self-referrals and referrals from professionals using this secure online form. If you prefer to post a form then please contact us, so we can send you a form to download.
Please do not send referrals to our general Bluebell email address.
The person being referred or self-referring should have been affected by depression/anxiety or mild to moderate perinatal mental health difficulties, during pregnancy and/or up to two years after birth
Prior to submitting form, please read our referral guidelines.
You can see our privacy statement here
All questions with red asterisks (*) are mandatory. You will not be able to submit the form unless you complete theses fields.
We recognise that maintaining the confidentiality of certain information is necessary and are committed to practices and procedures that reflect this. We believe that information our service users give to us in confidence should only be used for the purpose intended by the service user. Our staff and volunteers will not normally divulge information that could compromise a person’s safety or right to privacy however there may be times when a member of staff or volunteer consider it necessary to disclose information to others within the organisation or an outside agency for the sole purpose of the safety and wellbeing and the service user and/or their family members.
Please note that information contained in this form will be stored and processed as part of our legitimate interests. Full details are contained in our privacy notice. Please ensure that the referee is aware of this.
Thank you very much for your referral.