Please ensure you have read the referral eligibility criteria, and do not hesitate to contact the team should you have any questions:

West London Team (Ealing, Hounslow or Hammersmith and Fulham): 
Telephone: 020 3313 2022
Email: wlm-tr.maternitytlc@nhs.net

Central North West London Team (Brent, Harrow, Hillingdon, Kensington and Chelsea or Westminster):
Telephone: 020 7685 6384
Email: cnwl.maternitytlc@nhs.net

Please note: The Maternity Trauma and Loss Care service is not an urgent or emergency service.  If help is required urgently, please contact the relevant Mental Health Single Point of Access which is open 24 hours a day, 7 days a week, 365 days a year.

For residents in Ealing, Hounslow or Hammersmith and Fulham:
West London NHS Trust Mental Health Single Point of Access
Telephone: 0800 328 4444

For residents in Brent, Harrow, Hillingdon, Kensington and Chelsea or Westminster:
Central and North West London NHS Foundation Trust Single Point of Access
Telephone: 0800 0234 650

Section 1 - Consent

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Not eligible

Please note: consent must be obtained from the patient in order for the referral to be processed. Please seek consent from the patient before proceeding with a referral.

Section 2 - Referrer details

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Section 3 - Patient details

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Not eligible

As a North West London (NWL) service we are only able to offer care to women and birthing people who live in NWL boroughs.

Please consider speaking to the following professionals for further support: GP, their maternity service or their local NHS talking therapy service here.

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Patient contact details

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Tick all that apply

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Emergency contact

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Reason for referral

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We appreciate one or more may apply, please pick the one you feel where most help is needed. You will be able to share more of your concerns later in this referral process

Severe fear of pregnancy and/or child birth (also known as Tokophobia)

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Please note that as a North West London (NWL) service, we are only able to offer care to women and birthing people who are booked for their maternity care at one of the six North West London maternity hospitals.

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Not eligible

As a North West London service we're only able to offer care to women and birthing people who are booked for their maternity care at one of the six North West London maternity hospitals.

If they've booked at any other hospital, please speak to their GP or maternity service, or for NHS talking therapies, you can find their local service here.

Current symptoms

Please tick all that apply

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For example: avoidance of medical settings or procedures, difficulties bonding with unborn baby, limited or no support network etc

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Previous Mental Health History

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Please tick all that apply

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Risk

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Baby loss/pregnancy loss including termination for any reason

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Not eligible

As a North West London service we are only able to offer care to women and birthing people who have experienced baby/ pregnancy loss in the last 12 months.

If they have experienced baby/ pregnancy loss more than 12 months ago, please contact their GP or consider a referral to NHS talking therapies. You can find their local service here.

If you wish to speak to a member of our team please contact us on:

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Please note that as a North West London (NWL) service, we are only able to offer care to women and birthing people who are booked for their maternity care at one of the six North West London maternity hospitals.

Not eligible

As a North West London service we're only able to offer care to women and birthing people who are booked for their maternity care at one of the six North West London maternity hospitals.

If the patient has booked at any other hospital, please ask them to contact their GP, maternity or NHS talking therapies, you can find their local service here.

If you wish to speak to a member of our team please contact us on:

  • West London Maternity Trauma Loss Care: 0203 313 2022
  • Central and North West London West London Maternity Trauma Loss Care: 020 7685 6384

Current symptoms

Please tick all that apply

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Previous Mental Health History

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Please tick all that apply

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Risk

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Traumatic experience during pregnancy, birth or after birth

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Not eligible

As a North West London service we are only able to offer care to women and birthing people who have experienced trauma in their maternity journey in the last 12 months.

If they have experienced the trauma over 12 months ago. Please contact their GP or consider a referral to NHS talking therapies, you can find their local service here.

If you wish to speak to a member of our team please contact us on:

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Please note that as a North West London (NWL) service, we are only able to offer care to women and birthing people who are booked for their maternity care at one of the six North West London maternity hospitals.

Not eligible

As a North West London service we're only able to offer care to women and birthing people who are booked for their maternity care at one of the six North West London maternity hospitals.

If you have booked at any other hospital, please speak to your GP or your maternity or for NHS talking therapies, you can find their local service here.

If you wish to speak to a member of our team please contact us on:

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Current symptoms

Please tick all that apply

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For example: avoidance of medical settings or procedures, difficulties bonding with unborn baby, limited or no support network etc

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Previous Mental Health History

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Please tick all that apply

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Risk

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