Get Maternity Services - Self-referral Form - Uclh

Filling out the Maternity Services - Self-referral Form - UCLH online is a straightforward process designed to help you begin your maternity care journey. This guide will provide step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to acquire the self-referral form. This will allow you to access it in your preferred digital format.
2. Begin by entering your surname and forenames in the specified fields. Ensure that all names are spelled correctly.
3. Input your date of birth in the designated section, making sure to use the correct format.
4. If you have an NHS number, please enter it in the given field. If you do not have this number, you may leave it blank.
5. Provide your current address, including the postcode to assist with proper identification.
6. Enter your telephone number so that you can be contacted regarding your maternity care.
7. Fill in the name and address of your general practitioner (GP) to facilitate communication between care providers.
8. Indicate if you need an interpreter or British Sign Language (BSL) for your appointment by selecting 'Yes' or 'No'. If you selected 'Yes', specify your preferred language.
9. Identify any mobility, sight, hearing, or other needs that should be noted for your appointment by answering 'Yes' or 'No'.
10. State whether you have received any antenatal care from another hospital during this pregnancy by responding 'Yes' or 'No'. If applicable, specify which hospital.
11. Provide the first day of your last menstrual period or your estimated due date to help calculate your maternity timeline.
12. Indicate whether you are taking folic acid by choosing 'Yes' or 'No'. It is recommended to take folic acid up to 14 weeks of pregnancy.
13. Select the appropriate category that describes your ethnicity from the provided options to promote accurate demographic representation.
14. Finally, sign and date the form to confirm that the information provided is accurate to the best of your knowledge.
15. Once you have completed the form, you may save your changes, download, print, or share the form as needed.

Begin your maternity journey by completing the Maternity Services - Self-referral Form - UCLH online today.