Disclaimer: We share information with other professionals responsible for your care and will inform your GP that you have booked your maternity care with us.

Self-referrals are only accepted up to 33+6 weeks’ gestation for singleton pregnancies (or up to 27+6 weeks’ gestation for twin/multiple pregnancies).

We do not accept transfers of care for caesarean section unless medically indicated.
 

Pregnant people can refer themselves to our service by completing a self-referral form:

Your completed Word referral form can be posted or emailed to us using the details below.

We aim to contact all respondents within seven working days. We will then arrange your booking appointment and your first scan appointment. If you do not hear from us within seven working days, please call us on 020 3447 9400 (choose option 1)

First Appointments Centre
Antenatal Clinic
Integrated Antenatal Service
Elizabeth Garrett Anderson (EGA) Wing
University College Hospital
25 Grafton Way
London
WC1E 6DB

Telephone: 020 3447 9400
E-mail: uclh.antenatalreferrals@nhs.net

Complete and submit the online form on this page (below). 

Some fields are marked with "required" which means they must be completed in order to submit the form. 

We aim to contact all respondents within seven working days. We will then arrange your booking appointment and your first scan appointment. If you do not hear from us within seven working days please call us on 020 3447 9400 (choose option 1).

Required
Required
Date of birth Required
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Next of kin details

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Accessibility

Do you need an interpreter for your appointment (including British Sign Language)? (Interpretation services are free of charge) Required
Do you have any needs related to mobility, sight, hearing, learning disabilities or anything else that we should be aware of? Required

Medical history

Please be reassured that we treat this information confidentiality, and the purpose of these questions is to direct your care to the most appropriate care pathway.

1.Have you received any antenatal care from another hospital in this pregnancy? Required
2. First day of last menstrual period OR estimated due date: Required
3. Are you taking folic acid? (All pregnant people are advised to take folic acid up to 14 weeks of pregnancy) Required
4. Medical and mental health history Required
5. Do you have any infectious conditions (e.g. HIV, Hepatitis B, Syphilis)? Required
6. Do you or anyone in your household or immediate family have an infectious condition (e.g. HIV, Hepatitis B, Syphilis)? Required
7. Do you have sickle cell disease or a beta thalassaemia disorder (or carry either of these traits) Required
Required
8. Was this pregnancy conceived using a donor egg? Required
9. Have you received care during this pregnancy or a previous pregnancy from a Fetal Medicine Unit regarding diagnosis and/or treatment of complications in your unborn baby? Required
10. Are you expecting more than one baby (twins or more)? Required

How would you describe yourself?

Your ethnicity describes your cultural or ancestral heritage, which is inherited from your ancestors, your parents or grandparents. This may be different to your nationality, which is your legal identity, the country where you are a legal citizen. You may have been born in this country, or you may have moved here and become a citizen. Knowing your correct ethnicity is important to us as it helps us provide the best possible maternity care for you as an individual. Pregnant people from certain ethnic backgrounds can be more at risk for certain pregnancy complications.

ASIAN OR ASIAN BRITISH
MIXED
BLACK OR BLACK BRITISH
WHITE
OTHER ETHNIC GROUPS

Additional questions...

Are you interested in finding out more about Private Maternity care at UCLH?
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