Professional Referral Form

Refer a Family

Help connect a family experiencing pregnancy or infant loss with compassionate, trauma-informed support.

Pittsburgh Bereavement Doulas accepts referrals from healthcare providers, doulas, therapists, social workers, clergy, funeral professionals, community organizations, and other trusted professionals.

This field is for validation purposes and should be left unchanged.
Referring Provider Name(Required)
Please include the family’s preferred contact method. Text messaging is often the gentlest first contact.

Reason for Referral (Select all that apply)

Pregnancy
Planned Care (if known)
Current Needs & Interest in Services
Clients do not need to accept all of our services to be eligible. They are also welcome to talk to our team to decide before asking us to be their doula/support. This is especially relevant for families navigating diffiuclt decisions.
Timeline
Can we contact you about support?(Required)