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.

Online self referral

Can we email you with your booking appointment?
Will you require an interpreter?
Would you consider having a home birth? *
Would you like more information about home birth? *
Do you smoke? *

You are four times more likely to quit smoking if you have support from The Stop Smoking Service. They have specialist pregnancy advisers who can offer individual support and FREE Nicotine Replacement Therapy.