Pregnancy Self-Referral Form

Pregnancy Self-Referral Form

1. Welcome

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Please complete this form in order to make a self referral for antenatal care at St Thomas' Hospital. To order to help us understand your individual needs, please answer the questions as fully as possible. This will ensure that you are booked for the most appropriate care and place of birth. We will ask some initial questions about you and then further questions about your pregnancy, any previous pregnancies and your general health. Please have this information to hand if you do not know it. The form is 9 pages long and will take around 10-15 minutes to complete. If you need to, you can save the form and come back to finish it later. Thank you for choosing St Thomas's Hospital for your antenatal care.