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Congratulations! You're pregnant

The iconic clocktower at Medway Maritime Hospital with the sky behind it
A mum smiles and cuddles her newborn baby


Maternity Self-Referral Form

Thank you for choosing to have your baby at Medway. You now have two options. You can arrange your booking appointment by phone or by using our online self-referral form below.

If you need help completing the form or need an interpreter, please contact us.


Your personal details

Will you require an interpreter?

Your contact details


Your background


Your health record

Have you had a baby before? *
Have you had a baby before delivered via caesarean section? *
Would you consider having a home birth? *
Would you like more information about home birth? *
Do you have Type 1 diabetes? *
Do you have Type 2 diabetes? *
Are you or your family receiving any support from the following professionals? (tick all that applies)
Do you smoke? *

Your GP's details





Support during your pregnancy

A smiling obstetrician carries out an ultrasound on a pregnant woman