About this service

Self-referral to Colchester maternity services

You can refer yourself to our maternity service at Colchester Hospital

Please use the information below to complete an email to our maternity team.

The information you submit 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 please include the following information in an email to registermypregnancy.colchester@nhs.net


Please be sure to include all of this information otherwise we will not be able to accept your referral.

You can copy and paste the text below into your email.

Please include:

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 (e.g. Mrs, Miss, Ms)

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)

Please note: 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 on referral.bookingservice@nhs.net

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