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James Paget University Hostpital
Pregnancy self-referral

You can refer yourself to the James Paget for your maternity care by completing the form below.

Ideally you should book with us by 10 weeks of pregnancy.

Pregnancy self-referral form

If applicable
If known
This may be on any correspondence from the James Paget or the NHS - please supply this if you can.
Please check this is correct before proceeding
If you have provided us with an email address are you happy for us to contact you by email?
If you have provided us with a mobile telephone number are you happy for us to contact you by text? Please note calls/ texts from our hospital can show as 'unknown'
Ethnic group To ensure we provide the best care for everyone, we would like some additional information. You do not have to answer this question if you do not want to. Your answer will be treated as confidential and it will not affect the care that you receive.
Have you lived in the UK for the past 12 months?
Do you require an interpreter?
Do you have any medical conditions that require you to take regular medication?
You should also arrange an appointment with your GP to complete a medication review as soon as possible.
If not known please tick 'I am not sure' below
Have you had a scan?
If you have had a scan, please let us know on what date this occurred.
Have you received care at another UK hospital in this pregnancy?
Do you smoke?
Please confirm you are happy for us to store and process your data
Please tick to confirm

When you have completed and submitted the referral form, you will see a message confirming that this has been sent. 

We will contact you within 72 hours of receiving your referral to arrange your booking appointment with a midwife.

If you do not hear from us within this timeframe, please phone 07884 568788 and leave a message and this will be picked up by a member of staff on the next working day (Monday – Friday).

Please also ensure you let your GP know you are pregnant so that they can adjust any medication that you are taking.