Self-Registration Form for Maternity Care

Please share with us any information that you think is relevant to providing care for yourself or your baby. The answers you provide will allow us to pass your registration to the correct Midwifery or Obstetric Team; therefore it is essential that you share as much information as possible.

Registrations can also be made by calling your local community midwives’ office on (Aylesbury) 01296 316120 or (High Wycombe) 01494 425172.

Please do not use this service for any urgent medical queries as this service is only monitored during practice working hours on a daily basis.

Please note: If you have an urgent medical query you should telephone the surgery or contact the out of hours service by calling 111.

Self-Registration Form for Maternity Care
Please be aware we do not advise family or friends to translate on behalf of pregnant women during an appointment.
Continue on to Mother's Information

Mother's Information

Please use date format DD/MM/YYYY
Any responses will be sent to this email address
Available from your GP

Previous Pregnancy Information

Previous Birth Information

If more than 4 pregnancies, please only put the 4 most recent.

1.

2.
3.
4.

Medical History

Have you ever experienced either of the following?

Current Pregnancy Information

Social History

Office Use Only