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Pregnancy Self Referral Form for Women

Welcome to Calderdale and Huddersfield Antenatal Clinic

If you live outside of the Calderdale and Huddersfield area and your GP surgery is also out of the Halifax and Huddersfield area and you would like to have your baby at Calderdale Royal Hospital or Huddersfield Family Birth Centre, please complete this self-referral.

If you live in Calderdale or your GP is Calderdale please contact their booking line on 01422 261351 Monday to Friday 08.30 to 12.30, to arrange a Booking Appointment.

If you live in Huddersfield or your GP is in Huddersfield please contact their Booking line on 01484 355731 Monday to Friday 13.30 - 15.30, to arrange a Booking Appointment.

The Online Self Referral will then be submitted to the Antenatal clinic midwives who will arrange for your booking appointment to be sent to you.  You should receive a booking appointment in the post within 5-7 working days.

If you would like to discuss your booking or transfer of care, please contact the antenatal clinic midwives on 01422 224125 or 01484 342666 who will be happy to help you.

We look forward to hearing from you and providing you and your family with care.

Please follow the link below to complete your self-referral to our antenatal services

Pregnancy Self-Referral Form

CHFT - 454 - ooaform

In Area Patient or Out of Area Patient
Prior to completing

Prior to completing the next pages to self-refer, please click on the following links and read the information regarding your pregnancy, including food and diet, vitamins to take during pregnancy and screening options throughout your pregnancy.

Once you have read the above information regarding screening options and completed the self-referral, we please ask you to contact the Antenatal Clinic at Calderdale Royal Hospital on 01422 224125 to book your 1st scan as soon as possible.
Personal Details
Medical History
In order to enable us to plan your care effectively, please complete the following section with details of your previous medical history
Pregnancy Details
We would like to gather information regarding previous pregnancies and births in order to plan and individualise your care.
Social Circumstances
Anything extra