Refer yourself to Barnsley Hospital Maternity Services

Women who have a GP outside of Barnsley should not self-refer using this form.
You should see your community midwife or GP for referral if you wish to birth with us.
Are you registered with a GP Practice in Barnsley?(Required)
- Yes
- No
We're unable to offer you the option to self-refer.

Unfortunately you cannot use the self referral link, please contact your GP who will inform their community midwife of your pregnancy.

However if you do not have a GP, please contact our Community Admin Team on 01226 435369
Important note
Once you have completed this form, you will need to wait to see a green "Success" message to ensure your information has been recorded. If you have not received a response from our team within 5 days of successfully submitting your form, please call our team on 01226 435369.

About you
Name(Required)
First Last
Date of birth(Required)
Your NHS number (optional)

How do you describe your ethnicity?(Required)
How do you describe your partner's ethnicity?(Required)
Do you have any religious belief?(Required)
Religious belief(Required)
How would you describe your family origin? (optional)
This means what country your family originates from. This is useful for us to know before we offer you your first screening blood test.
What is your preferred communication language(Required)
Do you require an interpreter?(Required)
- no
- Yes
Other language(Required)

Your contact details
Your email address(Required)
Enter Email Confirm Email
Your phone number(Required)
Alternative phone number (optional)

Your address(Required)
Street Address Address Line 2 Town Post Code Country
How long have you lived at this address?(Required)
- More than 12 months
- Less than 12 months
Your previous address(Required)
This address should be different to your current address.

Street Address Address Line 2 Town Post Code Country

Your GP
Name of your GP(Required)
GP Practice(Required)
GP Post Code (optional)
GP Phone number (optional)

How we use your data
We use information collected in this form only for purposes related to your enquiry. Read more about how we use data in our general privacy policy, or request a copy of your data.

Barnsley Hospital NHS Foundation Trust

Covid-19 (Coronavirus): Please wear a mask in clinical areas of the hospital

Refer yourself to Barnsley Hospital Maternity Services

Step 1 of 7

About you

Your contact details

Your GP

You and your pregnancy

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