Make a Referral

Registered charity in England and Wales · Charity No. 1216132

A parent or carer can refer their own family, or a professional can make a referral for them. Every referral is reviewed and approved by Amelia's Light.

Referral Process:

Choose whether you are a parent/carer or a professional.
Parent and carer referrals are verified by the professional named below.
Amelia's Light checks and approves every referral.
If approved, we contact the family about next steps.

Who is making this referral?

Parent or Carer Professional

Family contact details

Please provide the details of the parent or carer whom Amelia’s Light may contact about this referral.

Parent or Carer Name* Parent or Carer Email* Parent or Carer Contact Number*

Professional details

Parents and carers: provide a professional who can verify this application.

Your Name* Your Work Email* Organisation / Hospital* Family Surname* Child’s Name* Hospital* Ward* Reason for Referral*

Upload Work ID or Proof of Role*

Upload Supporting Document (optional)