**IMPORTANT PLEASE READ** Please complete this form in order to make a self referral for antenatal care at St Thomas' Hospital (LONDON) only.

Please note, our antenatal midwifery care for out of catchment area patients will be relocating from St Thomas' Hospital, to Elephant & Castle area from Autumn 2024. Please check here to see if you will be affected by this - https://www.google.com/maps/d/viewer?mid=1e_VFhHS_iYmjecO8lu2MuR2yJ3vivkJm&ll=51.482131687513466%2C-0.16010904007313975&z=11 

In order to help us understand your individual needs, please answer the questions as fully as possible. This will ensure that you are booked for the most appropriate care and place of birth. We will ask some initial questions about you and then further questions about your pregnancy, any previous pregnancies and your general health. Please have this information to hand if you do not know it. The form is 11 pages long and will take around 10-15 minutes to complete. If you need to, you can save the form and come back to finish it later. Thank you for choosing St Thomas's Hospital for your antenatal care. It is normal for us to book your first trimester scan and then book your first midwife appointment so please do not worry if they are booked in this order.

Please note that if you have been receiving care in a different NHS hospital, and are over 30 weeks, the safest option for you is to remain with your current care provider. We will consider your request on a case-by-case basis, as we may not be able to safely provide the appointments you will require and may decline your referral for this reason.