Maternity Self Referral Form
Congratulations On Your Pregnancy!
Please complete the below form in order to notify us of your pregnancy. It is very important that you complete all mandatory fields (*) and that you provide us with your correct contact details. Please supply as much detail as possible when answering questions about your previous medical history or any current medication.
Self-referral Submission
Please allow 10 working days for us to process your form, after which you should receive your appointment date. If your GP surgery does not have a midwife who works there we will also contact you to arrange a booking appointment. If you have any queries regarding your referral please contact:
Maternity referrals – asp-tr.maternityreferrals@nhs.net.
Maternity referrals – asp-tr.maternityreferrals@nhs.net.