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
Congratulations on your pregnancy and thank you for choosing to have your maternity care at Imperial College Healthcare NHS Trust. We provide maternity care at two hospital sites – St Mary’s Hospital and Queen Charlotte’s & Chelsea Hospital. At both sites this includes midwifery-led birth centres and obstetric-led labour wards. We also offer care in the community, which includes home births.
If you would prefer to complete this form in another language, please scroll to the bottom right-hand side of the page and select your preferred language from the Google Translate menu. If you find it difficult to fill out this form, you can:
- book an appointment with your GP instead, and they will refer you.
- Call us on 020 3313 5222 and give us your details over the phone or
- Come to the antenatal clinic at Queen Charlotte's & Chelsea Hospital or St Mary's Hospital.
Please provide as many details as possible when completing this form. This will help us ensure you see the right team for you as soon as possible.
We will let your GP know that you have booked your maternity care with us.
Your first midwife appointment will either be at a clinic in the hospital or in a community centre. At this appointment you can discuss where you would prefer to have your pregnancy care, as well as where you would like to give birth.
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