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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.

Please complete the Self Referral Form as SOON as you have a positive pregnancy test. An automatic acknowledgement will NOT be sent. We will the contact you by phone to offer you a face to face booking appointment when you are between 8-10 weeks pregnant. This call will be from an unknown number to your given contact 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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Is the father of the baby the next of kin?
Address (if different to your own)
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If you answered yes, please tick one of the following options.
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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?
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Can you access the screening and pregnancy information available on the website prior to your scheduled booking appointment?
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East Cheshire Trust hosts maternity research studies, which can improve care for generations of mothers and babies. Would you be happy for our Research Midwife to speak to you to find out more about participating in current and future studies?

Further advice

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.

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