Maternity self-referral form

If you would like us to care for you when you are having your baby, you can let us know by completing the self-referral form below. East Kent Hospitals offers a range of maternity care services in hospital at the William Harvey Hospital and Queen Elizabeth The Queen Mother Hospital.

If you have underlying medical conditions we have a large team of experts at hand to look after you.

We will write to your doctor (GP) to inform them that you have booked with us.

After you submit this form a notice will appear on your screen confirming it has been submitted.  This will then be followed up by a confirmation email to you.

If you are unable to complete the self-referral form below please contact us on 01227 868772. A member of the maternity team will call you back and take your details over the phone.