Pregnancy Self Referral Form

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Special Requirement

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GP Details

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Your Clinical Details

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Regarding any previous pregnancies, how many of the following have you had?

Regarding previous births, how MANY times and WHERE have you delivered?

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To book your pregnancy care you do NOT need to visit your GP for a referral

Please complete the form below to book your antenatal care and delivery with Darent Valley Hospital. After you submit this form a notice will appear on your screen confirming it has been submitted.  

Your maternity appointments will be sent to you via email, unless you choose not to use this option. If you have not chosen to receive your appointment via email, it will arrive via post. We aim to provide you with the earliest available appointment in your area and provide a scan date from between 12 weeks to 13 weeks and 6 days of pregnancy.

You can complete the online self referral form below or print off a word version send it to us via the Community Midwives Office, c/o Delivery Suite, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent  DA2 8DA. 

Please note that postal communication may delay you receiving appointments. 

Overseas visitors

If you are a visitor from overseas you may be asked to provide the following details, to help clarify that you are entitled to National Health Service (NHS) care.

Documentation which overseas visitors will be asked to provide

  • The European Health Insurance Card (EHIC)

  • A valid passport with current Visa in place

  • Travel documentation which proves that you are “insured” in your country of origin – entitlement to “necessary treatment”.

Demonstration that they live in UK (longer than 1yr)

  • Residence permit, identity card, social security care, housing contracts, utility bill in your name, bank statements.

Postal address for all enquiries

Community Midwives Office, c/o Delivery Suite, Darent Valley Hospital, Darenth Wood Road, Dartford, Kent DA2 8DA. 

To re-arrange any existing appointments contact the Community Midwives Office on 01322 428753, the local Children’s Centre or your GP.

Parent education classes

For further information on your pregnancy and birth choices including parent education classes.  You can book these classes yourself online.

After submitting the form

Once you have submitted an online self referral your appointment dates will be sent to you via post and may take SEVERAL WEEKS.

On receiving your self referral form to tell us you are pregnant we will arrange your first visit with a Midwife. This is known as the ‘booking’ visit. It gives you the opportunity to meet your Midwife and start planning your pregnancy care. This will take place at your local GP Surgery or Children’s Centre, at your home, or in our Antenatal Clinic.

You will be able to discuss the choices available to you at Darent Valley Hospital. This will take a few weeks to arrange.

For information on antenatal / screening tests for you and your baby visit: https://www.nhs.uk/conditions/pregnancy-and-baby/screening-tests-abnormality-pregnant/