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Home » Our Services » Maternity (Obstetrics) » Maternity Services – Luton and Dunstable University Hospital » Early Self-Referral to a Community Midwife at the L&D

Please be aware, the information on this page relates to Luton & Dunstable University Hospital

Early Self-Referral to a Community Midwife at the L&D

Please note this form is for patients self-referring to the L&D

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 01582 497020, 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 (*)

By ticking this box you can confirm you have accessed the screening information link above. Please ensure you have accessed the link before continuing with this form.*

Name*

Address*

Home contact number*

Mobile contact number

Work contact number

Date of birth*

Mothers Ethnicity

Fathers Ethnicity

NHS Number (optional)

Hospital number (if known)

GP name, address and telephone

Date of your last period

Any previous pregnancies?

Yes No

If yes, were any born at the L&D?

Yes No

Is English your first language?

Yes No

If no, do you require an interpreter?

Yes No

Do you have a disability?

Yes No

Do you currently consider yourself to have any medical problems?

Yes No

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

Please note this form is for patients self-referring to the L&D

In this section

Maternity videos
Early Self-Referral to a Community Midwife at the L&D
Choosing to have your baby at the L&D
Before the birth
Choice of place of birth
Giving birth
After birth
Breast feeding and infant formula
Community support
Meet the team or get involved
Fetal Medicine
Maternity information for families in different languages

Contact

Bedford Hospital, South Wing, Kempston Road, Bedford, MK42 9DJ

Email: [email protected]

Phone: 01234 355 122

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Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ

Email: [email protected]

Phone: 01582 491 166

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