Booking to have your baby with Western Sussex Hospitals NHS Trust

This form enables you to book yourself into Worthing Hospital or St Richard's Hospital, Chichester for the birth of your child.

Please click on the following link for information on vitamins recommended in pregnancy: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vitamins-minerals-supplements-pregnant.aspx#close

The Department of Health Pregnancy Book is available here for information about diet, lifestyle and more: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107302

For Screening information for you and your baby: http://www.screening.nhs.uk/getdata.php?id=7885

To work out your BMI, which is a required for this form, please click on the following link: http://www.nhs.uk/tools/pages/healthyweightcalculator.aspx

Please take the time to read the information booklet about scans and blood tests, please click on the following link:
https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby-description-in-brief

Please complete the form below and click Submit.

The information you enter into this form will be used to prepare for your visit for the birth of your child. Everyone working with the Trust must keep your information confidential and secure and share it only when necessary to provide you with the proper care during your stay. The fields marked * are compulsory but it is recommended that you complete as many optional fields as you can so that we have enough information to contact you in the case of a cancellation. By completing these optional fields you consent to us contacting you via this method. For example, by entering a phone number you consent to us contacting you by telephone. In this case you should bear in mind that someone other than yourself may answer the phone.

A copy of this form will be sent to your GP to notify them that you are planning on having your baby at the selected hospital

If you wish to clear the form of any data entered, click Reset.

Select A Hospital *  
NHS Number
Surname *  
First Name(s) *  
Maiden Name  
Date Of Birth *    
Address*  
Post Code *  
Phone Number *  
Nationality *  
Do you need an interpreter? *  
What language do you need an interpreter for *  
Doctor's Name *  
Doctor's Address *  
What is the first day of your last period?

Have you had children before? *  
Height in metres (i.e. 1.45) *    
Weight in kilos (i.e. 64)*    
Body Mass Index (It is very important if your BMI is over 30 at booking that your GP prescribes 5mg Folic Acid for the first 12 weeks) *    
Any other information you think we might need e.g. any medical conditions

E-mail Address