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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 (*)

Any previous pregnancies?

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

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.

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