Your cookie preferences

We store cookies on your device to make this website work. We would also like to use analytics cookies. These collect and send information about how our site is used to services such as Google Analytics. We use this information to improve our site. If you accept these additional cookies, a cookie will be stored to save your choice. You can update your consent to using these cookies at any time.

Cookie types explained
  • Essential: Essential cookies enable basic functionality and are necessary for the website to work properly.
  • Analytics: Analytic cookies collect information anonymously. This information helps us to understand how our visitors use our website.

Post-Natal Self-Referral Form

Please only complete this form if you have received your maternity care from Calderdale and Huddersfield NHS Foundation Trust.

The form takes 15-20 minutes to complete, so please ensure you have time to complete the form fully in one sitting.

PPHS Post-Natal Self-Referral Form - Pre-Form

PPHS Post-Natal Self-Referral Form

PPHS Post-Natal Self-Referral Form

Section 1: Patient Details
Section 2a: Birth Information
Section 2b: Postnatal Symptoms

Please ask your GP to refer you to your local Perinatal Pelvic Health service.

In this section: