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Maternity self-referral

Booking to have your baby with East Sussex Healthcare NHS Trust's Maternity services

This form enables you to book yourself into East Sussex Healthcare NHS Trust's Maternity services for the birth of your child.

The following are links to useful information:

  • Information on vitamins recommended in pregnancy - click here>>
  • To work out your BMI, which is a required for this form - click here>>  

Please complete the form below and click Submit.

The information you enter into this form will be used to prepare for your visit for the birth of your child. Everyone working with the Trust must keep your information confidential and secure and share it only when necessary to provide you with the proper care during your stay. The fields marked » are compulsory but it is recommended that you complete as many optional fields as you can so that we have enough information to contact you in the case of a cancellation. By completing these optional fields you consent to us contacting you via this method. For example, by entering a phone number you consent to us contacting you by telephone. In this case you should bear in mind that someone other than yourself may answer the phone.

A copy of this form will also be sent to your GP to notify them that you are planning on having your baby at the selected hospital.

If you wish to clear the form of any data entered, click 'Reset'.

Please note
Once you have completed your self-referral, please click the 'submit' button and then check your email where you will receive confirmation that the Trust has received your details.

Your information will then be processed and you will receive an ‘Ultra Scan Appointment’ through the post. The Community midwife will aim to contact you prior to the Ultra Sound scan appointment where she will liaise with you regarding a convenient date and time to perform your booking.

» Indicates required fields

Maternity self-referral
Do you have good spoken and understanding of English? »
Have you had children before? »
Do you have any under lying health conditions?
Are you on any regular medications?
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