Maternity Self Referral

Please use the form below to book to have your baby with East Sussex Healthcare NHS Trust’s Maternity services.

The following are links to useful information:

Work out your BMI, which is a required for this form

Please use this form to make your Maternity Self Referral



























































  • (it is very important if your BMI is over 30 at booking that your GP prescribes 5mg Folic Acid for the first 12 weeks)


Please note

Once you have completed your self-referral, please click the ‘submit’ button. You will be sent an email confirming that we have received your details.

Your information will 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.

Your information

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 your selected hospital.

Important

This website is secure and the information you enter on this form is secure (please see the padlock symbol in the address bar). The information you submit on this form is NOT stored on this website.