Request an Appointment with a Midwife

If you would like to request an appointment with a Midwife, please submit this form.

Please be aware that any replies from the surgery may appear in your Junk Inbox.

Request an Appointment with a Midwife

Request an Appointment with a Midwife

Section

Have you already self-referred to a hospital? *
Would you like to self refer now? *

You should self-refer to whichever hospital you want to have the baby when you discover you are pregnant. You do not need to see the GP unless you have any medical concerns.

Visit University Hospitals of Derby and Burton's website:

Alternatively, visit your local Hospitals website to self-refer.

Please use date format DD/MM/YYYY