BPAS | Make a referral

It's easy to refer your patients to our services

You or your patient can contact BPAS to explore treatment options and book a consultation by calling 03457304030.
GPs or other healthcare professionals can call our Referral Support Hotline on 03332342435 if you want to refer a patient with complex medical needs, if your patient is vulnerable, or if you have other concerns.
Phone lines are open Monday to Friday: 7am - 6pm Saturday: 8am - 4pm Sunday: 9.30am - 2.30pm. Calls are charged at a local rate.
Appointments are available from approximately 55 clinics located across England, Wales and Scotland

Call: 03457 30 40 30

Referral forms are available below

Referral Form	Download
Termination of pregnancy (TOP) PDF and Word (protected), allows completion of form fields only. Word (unprotected) to load to your information systems.	PDF Termination of Pregnancy Referral Form Word (protected) Termination of Pregnancy Referral Form Word (unprotected) Termination of Pregnancy Referral Form
Termination of pregnancy for fetal anomaly There is an alternative patient pathway for TOPFA referrals from NHS Units. Please print the PDF, complete and fax or email it to the treatment unit or contact centre.	Fetal Anomaly Referral Form (PDF)
Prison healthcare providers Refer clients in custody by completing the referral form and emailing it to custodial.referrals@bpas.org. For more information about how we treat women who are serving a custodial sentence click here	Prison Custody Termination of Pregnancy Referral Form (PDF)
Vasectomy referral forms PDF and Word (protected), allows completion of form fields only. Word (unprotected) to load to your information systems.	PDF Vasectomy Referral Form Word (protected) Vasectomy Referral Form Word (unprotected) Vasectomy Referral Form
HSA1 Form	HSA1 Form (PDF) HSA1 Form (Word)

Referral Form

Download

Termination of pregnancy (TOP)

PDF and Word (protected), allows completion of form fields only.

Word (unprotected) to load to your information systems.

PDF Termination of Pregnancy Referral Form

Word (protected) Termination of Pregnancy Referral Form

Word (unprotected) Termination of Pregnancy Referral Form

Termination of pregnancy for fetal anomaly

There is an alternative patient pathway for TOPFA referrals from NHS Units. Please print the PDF, complete and fax or email it to the treatment unit or contact centre.

Fetal Anomaly Referral Form (PDF)

Prison healthcare providers

Refer clients in custody by completing the referral form and emailing it to custodial.referrals@bpas.org.

For more information about how we treat women who are serving a custodial sentence click here

Prison Custody Termination of Pregnancy Referral Form (PDF)

Vasectomy referral forms

PDF and Word (protected), allows completion of form fields only.

Word (unprotected) to load to your information systems.

PDF Vasectomy Referral Form

Word (protected) Vasectomy Referral Form

Word (unprotected) Vasectomy Referral Form

HSA1 Form

HSA1 Form (PDF)

HSA1 Form (Word)

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We are an independent healthcare charity which for more than 55 years, has been advocating and caring for women and couples who decide to end a pregnancy.