Maternity Self Referral

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

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

My Pregnancy and Birth Choices

This booklet is for you to download and print. It will help you make informed choices around your care and can be used for you to record your thoughts and feelings during this journey.

Use it to spark conversations with your Midwife and Maternity team. This does not form part of your medical record and is yours to keep. If you don’t have access to a printer speak to your named midwife.

Please use this form to make your Maternity Self Referral with East Sussex Healthcare NHS Trust's Maternity services

Please note

Once you have completed your self-referral, please click the ‘Please click here to make your referral’ 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.

*subject to you entering a valid email address

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 at 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.


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.