Self-Referral Form

As soon as you have a positive pregnancy test, you can now refer yourself directly for maternity care Hospital within the South Eastern HSC Trust.

Please complete the form below and email it to the relivant address. Upon receipt, midwives will arrange the first booking appointment for you, and also notify your GP of your pregnancy.

Self-Referral Form

If you have any queries regarding this form or if you have not received an appointment by the 12th week of your pregnancy please phone:

  • Ulster Maternity: (028) 9056 1364
  • Lagan Valley Midwifery Led Unit: (028) 9263 3534
  • Downe Midwifery Led Unit: (028) 4461 6995

Please return via email your completed form to:

  • LaganValley.Midwives@setrust.hscni.net
  • Downe.Midwives@setrust.hscni.net
  • Maternity.Reception@setrust.hscni.net