If you are pregnant and require maternity services, you can self-refer to our hospital using the form below. It is important you receive maternity care early in your pregnancy, so please complete our form as soon as you find out you are pregnant.

Please complete all fields to your best knowledge, it is important that you provide your name, date of birth, address and contact details so that we can quickly get in touch with you to talk about your pregnancy and the care.

* Required information

About you

Your contact details

If you are not sure of this, just enter '0000'

Please complete all address fields in full so that we can contact you as quickly as possible.

Your GP

Your next of kin

Please let us know who we could contact in the event of an emergency.

Your current pregnancy

The following questions help us to understand your situation, when you will need your first scan, and what kind of maternity care you might need. Please answer as best you can. We will discuss your responses further at your first appointment.

If you are already past the 10-week mark, don’t worry. We will aim to see you within two weeks and arrange all necessary tests.

If you aren’t sure, your best guess is fine

Please bring information about your IVF cycle to your appointment and first scan. If you don’t know the answers to the three questions above, please check with your IVF clinic.

Your general health

Previous pregnancies

Sadly, sometimes a previous pregnancy can end in a loss. We offer bereaved parents special support in later pregnancies, as this can be a difficult and stressful time.

Low-risk pregnancy

Women whose pregnancies are low risk (no medical problems or serious complications in previous pregnancies) are offered midwife-led care throughout their pregnancy, during their labour and after delivery.

If yes, a midwife will contact you by phone to ask you more detailed questions.

Mental health

Mental health in pregnancy is just as important as physical health. We have special teams of midwives and doctors to provide support for parents with mental health difficulties.

Home life

We understand that these questions may be sensitive. Please answer honestly so that we can arrange extra support for you and your family.

Preferences for care

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. Our teams across both hospital sites and the community work together as one maternity service to deliver the best quality of care for you and your family. You can expect most of your midwife appointments to be held at a community centre near you.

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