Application to the Doula Access Fund

Details of the person / organisation making the referral

Details of the service user

Please confirm the service user is experiencing financial difficulty* *
*Proof of receipt of benefits or no recourse to public funds will be required. (You can upload a file below or email proof to
Which service are you applying for? *
If an available local doula cannot be found would the client consider virtual support?
Supporting evidence (proof of benefits)
Maximum upload size: 67.11MB