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Apply For Cherish

CHERISH Application

Use this form to apply for donor expressed breast milk
Person with a diagnosis
Name

Please use your full name as it appears on your NHS records
Address
Street Address Address Line 2 City ZIP / Postal Code Country

Enter your current home address
NHS Number
This is a 10 digit number, you can find it on letters from your GP or with the NHS app
Date of birth
DD slash MM slash YYYY
GP Practice

Enter the name of your registered GP practice
Baby receiving donor expressed breast milk
Baby's Name
Address
Street Address Address Line 2 City ZIP / Postal Code Country

Only enter this if it is different from the address above
NHS Number
If you have it, enter your baby's NHS number
Date of birth
DD slash MM slash YYYY

Enter your baby's date of birth
Health Visitor
First Last
Enter the name of your Health Visitor, if known
Your agreement
Please tick to confirm
GP confirmation
This is needed before donor milk can be provided
- I understand that I will need to ask my GP for a letter confirming my diagnosis.
Recording donor milk
This helps keep records accurate and safe
- I understand that my GP or HV will record donor milk batch numbers in my baby’s red book
Equality and Diversity information (optional)
If you have cultural, religious, or personal concerns about this choice, feel free to talk with the CHERISH team. You do not have to provide this information.
Ethnic Origin
First Language

Enter the main language you use
Religion

If you have one
Gender

Enter the gender you identify with
Sexual orientation

If you choose to share this
Relationship status

For example single or married
Before you submit
Check that the information you have given is correct. If you have questions or need help with this form, contact the CHERISH team.
Phone
This field is for validation purposes and should be left unchanged.

Telephone Number 01244 362226 or [email protected]

Apply For Cherish

CHERISH Application

Person with a diagnosis

Baby receiving donor expressed breast milk

Your agreement

Equality and Diversity information (optional)

Before you submit

We have provided milk to over 70 hospitals since 2014

For Help and Advice

Telephone Number 01244 362226 or [email protected]

Apply For Cherish

CHERISH Application

Person with a diagnosis

Baby receiving donor expressed breast milk

Your agreement

Equality and Diversity information (optional)

Before you submit

We have provided milk to over 70 hospitals since 2014

For Help and Advice

Connect with us