IMPORTANT
If you are a grandparent or other relative, please don't use this form.  Instead use the contact us form.


Please complete the referral below and we will be in touch with further information.  Don't forget to make sure your midwife/health visitor and GP know how you are feeling.


There is a link to our privacy notice at the bottom of the page to let you know how we handle the information you provide.  A lot of the questions below require an answer before you can submit the form so please make sure you have completed all sections, especially the ones with red writing.  If the form won't submit it's almost definitely because you've missed a question.   If you're still having problems submitting the form please give us a ring 0121 301 5990 or message us, we're here to help.  

Our dads'/partners' support service is available for dads/partners in Solihull as well as Birmingham.  If you are a Solihull based dad/partner just click yes to answer the first question below.  Unfortunately we don't support mums in Solihull at the moment.