You can refer yourself to our maternity service at Colchester Hospital

The information you send to us will be treated in confidence and in order to provide appropriate care for you and your baby we may need to share information with the wider care team. We will take your email as an agreement to share your information.

To self refer email the team.

Please include the following information You can copy and paste the text below into your email. We need all this information in order to accept your referral.

You doctor’s details

The name of the doctor you are registered with

The name of the surgery where you are registered

Your details

Your title

Your full name (First name and Surname)

Your previous Surname (If you had one)

Your date of birth (in format dd/mm/yyyy)

Your NHS Number (If known)

Your Hospital Number (If known)

Your address

Your post code

Your contact number

Your email address

Your preferred method of contact (e.g. email, phone)

Your first language (if not English)

Your ethnicity

If you require an interpreter (interpreter required, no interpreter)

If you have lived in the UK for the past year

Medical and obstetric (maternity) history

What was the first day of your last period (in format dd/mm/yyyy)(approximate date if not sure)

The number of previous pregnancies you have had (if none please state ‘no previous pregnancies’

If you have had a miscarriage before (if none please state ‘no miscarriages’

If you have had any terminations before (if none please state ‘no terminations’

Please tell us of any other medical conditions you have

If you are a smoker (e.g. smoker, non-smoker)

If you have any previous pregnancy history (e.g. caesarian section, Pre-eclampsia)

Next of Kin details

Name of next of kin (First name and Surname)

Next of kin date of birth (in format dd/mm/yyyy)

Next of kin address

Next of kin post code

Next of kin contact number

Next of kin Relationship to you (e.g. partner, mother)

You will receive an email response from us as soon as possible – please check your junk folder for this if it does not come to your inbox.

Please do not resubmit the referral form, if you have not had an email response from us. We are processing referrals as quickly as we can, but due to the high numbers being received, it is taking slightly longer than usual. Do not worry, this will not affect your care.

If you need urgent assistance, please contact us on 01206 742 369. Thank you for your patience.

Any information you send to the maternity team will be from an unsecure server, however any reply you receive from the team will be sent via a secure server. Find out more about how we protect your information.

Diabetes

If you have diabetes, please also refer yourself to the North East Essex Diabetes Service (NEEDS). Either ring on 0345 241 3313 option 2 or email NEEDS.

Other conditions

• Are you and/or the baby’s other parent carriers of sickle cell, thalassaemia or another haemoglobin variant?
• Are you already known to have HIV, Hepatitis B or Syphilis?
• Have you had a baby previously who was born with a chromosomal or genetic condition such as Down’s, Edward’s, Patau’s Syndrome, duchenne’s syndrome, cystic fibrosis? (this list is not exhaustive)

If so, please also email the Antenatal and Newborn Screening Team with your name, contact details and details of the above conditions.