Maternity self-referral form

If you are pregnant and would like to come to Hillingdon Hospital to have your baby, you do not need a referral from your doctor. You can now contact a midwife as soon as you find out that you are pregnant to speed up your access to maternity care. We will pass on the information in the form to your GP. Any queries regarding antenatal appointments or postnatal visits ONLY please contact us either on line at or ring 01895 279442.

If you have not received a confirmation letter stating that we have received your referral  in the post within 6 working days of submitting the referral on line then please re refer.

Important: Please either use a laptop or desktop computer to send in a self referral as we do not always receive referrals sent from a phone or tablet. You can also come in and fill out a referral or go to your GP .

You can also fill in a Word Self-Referral Form (59KB, Word) and send it to us at: Maternity, Hillingdon Hospital, Pield Heath Road, Uxbridge UB8 3NN, or email it to

Allow 14 working days for us to process it, after which you should receive your booking and scan appointment dates. Any queries, please contact the antenatal clinic on 01895 279442.

When completing the form please remember to include any medical history this includes any condition not related to pregnancy, eg. blood clotting disorders, epilepsy, diabetes, thrombocytopenia. Please share your medical history with us as it helps in planning your care.

What Happens Next

The Self-Referral Form will be received by our antenatal clinic staff at Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex UB8 3NN. Tel. (01895) 279442. Please allow 14 working days for us to process this form after which you should receive your booking and scan appointment dates.

We advise all pregnant women to take folic acid tablets for the first 12 weeks of their pregnancy. For most women the dose is 400micrograms (0.4mg a day). If your risk of having a child with a spinal cord problem is increased then the dose is higher (5mg a day – you will need a prescription for a higher dose). If you think you are at risk, speak to your doctor or midwife.