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Please be aware, the information on this page relates to Bedford Hospital

Early Self-Referral to Maternity Services at Bedford Hospital

Please note this form is for patients self-referring to Bedford Hospital

Once this form has been completed it will be sent to the Community Midwifery Services who will arrange your initial booking appointment with you, on the number you provide below.

If you are more than 9 weeks, please contact us as soon as you have submitted your referral form so we can process your referral and book you an appointment as soon as possible.

Please contact us if you have not heard from us within 15 working days, you can call 07767 441563 throughout Monday to Friday from 9am to 4pm. This number will get you through to our Community Team Ward Clerk.

Read about screening information

PLEASE DO NOT FILL IN THE FORM BELOW BEFORE READING THE SCREENING INFORMATION ABOVE.

Antenatal Self-Referral

Please complete all fields marked with an astrix (*)

Any previous pregnancies?*

If yes, were any born at Bedford Hospital?*

Have you previously had a baby diagnosed with Down's syndrome, Edward's syndrome or Patau's syndrome?*

Are you English speaking?

Do you smoke?*

Thank you for your enquiry, we will be in touch shortly.

Please note the above form is for patients self-referring to Bedford Hospital.

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