Just found out you are pregnant?

Please complete the online self-referral form below with as much detail as possible. A midwife will contact you to arrange your maternity screening tests and first appointment as soon as possible. We’re looking forward to meeting you and giving you the best care that we can through your maternity journey.

Please note: the maternity department at East Surrey Hospital serves local residents in Redhill, Reigate, Dorking, Horley, Horsham and Crawley. Please only complete this form if you wish to have your baby at East Surrey Hospital.

If you have previously had a pregnancy confirmed with a full trisomy for T21, T18 or T13, there is a new blood test available called R445 (NIPT) which replaces the offer of the combined or quadruple test.

This test allows you to proceed to a more sensitive test at an earlier stage of pregnancy taken from 10 + 0 weeks. The previous pregnancy should have a result of an affected pregnancy and NOT for a previous high-chance first trimester / quadruple screening test result. The R445 it is a screening test for trisomy 21, 18 or 13  it is not a diagnostic test and so will not detect all pregnancies with these trisomies. If you have had a previous pregnancy affected please complete this section clearly so that the Antenatal Screening Department can arrange an early scan – if this pregnancy is a result of a donor egg - you will not be eligible for R445 testing as the increased prior chance does not apply.

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Further Details

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Do you have any of the following special requirements? If "yes" please give details:

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Health conditions

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Details about your GP

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Information about your current pregnancy

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Regarding any previous pregnancies, how many of the following have you had:

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Regarding previous births, how many times have you delivered by

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Transferring your care with us

If you have recently moved into our catchment area or wish to move your from another hospital to us, please complete the self-referral above.

Thank you for choosing your care with us and we look forward to meeting you.

Transferring your care to another hospital

If you have decided to have your care with another hospital, please contact your chosen hospital on how to do so.

Please inform your community team that you are transferring your care to stop future contact from SASH Maternity regarding appointments.