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

Early Self-Referral to a Community Midwife

Please note

Once this form has been completed it will be sent to the Community Midwifery Services where the Community Midwife directly attached to your GP will be in touch with you, on the number you have provided.

Please contact us if you have not heard from us within 10 working days, you can leave a message for your midwife at your GP surgery or call 07788415854/ 07788415849, this number will get you through to maternity reception.

Please click here to 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 Hosptial?

Is English your first language?

If no, do you require an interpreter?

Do you have a disability?

Do you currently consider yourself to have any medical problems?

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