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.