Use this online form to self-refer to maternity services at Queen Charlotte's & Chelsea and St Mary's hospitals. It is important to start your antenatal care early in your pregnancy, as soon as you find out you are pregnant.
Antenatal self-referral form
Completing your self-referral form
Please complete all fields on this form so that we can proceed with your booking and set up your first appointment as soon as possible.
Once we've processed your self-referral, you will be offered a face-to-face booking appointment with one of our midwives. If you have any sensitive information you wish to share before that appointment, you may contact the maternity helpline at 020 3312 6135.
If your form cannot be submitted due to a technical fault, please return to the antenatal referral page where you will find alternative ways to complete your self-referral.
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