Maternity Self-Referral Form

Confidential

This form is treated as confidential

Please complete this form to receive maternity care from Mid and South Essex NHS Foundation Trust.



Submit all required details promptly after a positive pregnancy test to ensure timely appointment schedulling. Incomplete submissions may cause delays.



You will be contacted between 8 and 10 weeks of pregnancy. If you are over 10 weeks you can expect contact within 7 working days.