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Self Referral Form for Antenatal Care

Congratulations on your pregnancy! Thank you for choosing Macclesfield District General Hospital for your care.

Once you have submitted this form an automatic acknowledgment will not be sent, however, we will contact you at a date closer to you being 8-10 weeks pregnant to arrange your appointment. This will be an unknown number to your given contact telephone number.

If you are unable to submit an online referral please leave a voicemail with your contact details on 01625 661163, this number is not manned and is a voicemail service. We will then return your call in due course to take your details.

If you think you are over 10 weeks pregnant please call 01625 661160 for your appointment to be arranged. 

If you have any non-urgent queries regarding your pregnancy and keeping well in pregnancy, you can find information available here.

It is advised that all pregnant women take folic acid 400mcg and vitamin D 10mcg daily, these are available to purchase at various retail outlets. If your BMI is above 30, you are diabetic or you have a family history of any neural tube problems (such as spina bifida), you should see your GP to obtain a prescription for higher dose folic acid.

Screening tests will be offered to you during your pregnancy, as well as when your baby arrives. There is information available for these tests here.

If you are diabetic it is recommended you book at an alternative hospital to receive the correct care from a diabetic team alongside the team midwives in your local area.

What to expect at your booking appointment


Self Referral Form

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Address
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Baby’s father details

Is the father of the baby the next of kin?
Address (if different to your own)

Current partner details (if not baby's father)

Address (if different to your own)
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Is there any member of yours, or baby's biological fathers family from any country other than the United Kingdom?
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Do you currently smoke, or have you recently stopped smoking?
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Does anyone in your household smoke?

If you've answered 'yes' to either or both of the two questions above and would like some advice on giving up smoking, please contact Kelly on 07385373054 to discuss.

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Can you access the screening and pregnancy information available on the website prior to your scheduled booking appointment?

It is advised that all women take Vitamin D 10mcg daily, these are available to purchase at various retail outlets.

If your BMI is above 30, you are diabetic or you have a family history of any neural tube problems (such as spina bifida), you should see your GP to obtain a prescription for higher dose folic acid.

Required