Maternity - Self referral

Congratulations on your pregnancy

Please tell us a bit more about yourself by completing the maternity self referral form. The form asks questions about yourself and your medical history.  Please answer as fully as possible, as this will ensure that you receive the most appropriate care.

PLEASE ENSURE YOU FILL ALL THE MANDATORY FIELDS ON THE FORM (THOSE MARKED WITH AN ASTERISK) OR IT WILL NOT SUBMIT AND WILL NOT BE RECEIVED BY THE MATERNITY BOOKINGS TEAM. IF YOU SUBMISSION HAS BEEN SUCCESSFUL YOU WILL RECEIVE A RESPONSE PAGE BACK IMMEDIATELY.

If you require any support with our online form please call our designated phone number 01823 343321. This is an answerphone and we may take up to three working days to get back to you. Please leave your contact details and a member of our team will get back to you.

Those wishing to book to have their baby in Bath please do not complete this form. Contact Paulton Birth Centre on 01761 412107 or Shepton Mallet Birth Centre on 01749 342378.

Please be advised that St Michaels Hospital in Bristol are no longer accepting referrals from Somerset residents at this time. If there is a medical need to deliver at St Michael’s Hospital, you will be referred by your health care professional once assessed.

Maternity Booking Form