Skip to Main Content Skip to Site Map Skip to Accessibility Statement
Home Our Services Maternity services Self-referral form for Maternity Care

Self-referral form for Maternity Care

Self-Referral for Maternity Care

As soon as you have a positive pregnancy test you can self-refer for maternity care.

Please complete this form and upon receipt the Midwives will arrange your first booking appointment.

If you have any difficulty completing the form below or you get an error message please email antenatal.midwives@southerntrust.hscni.net please check your spam mail for email confirmation. There is no need to send your self-referral more than once. The team will respond to your self-referral form as soon as possible. If you have not received an appointment by 12 weeks please contact us.

Click here to view our dedicated maternity webpages for more information.

  • DD slash MM slash YYYY
    Please note the first booking scan appointment is done in our main hospital sites Craigavon, Daisy Hill, South Tyrone and Armagh Community hospital, you then can be seen in your local community team for follow on appointments.
  • DD dash MM dash YYYY

  • By submitting this form you confirm that the information you have provided is accurate.

Also in this Section