Maternity Self Referral Form for Wrightington, Wigan and Leigh
If you have any difficulties using the Maternity booking form, please contact your own GP or local community midwife team.
The information provided will only be accessed by the maternity team in order to protect your confidentiality.
This is an initial screening form and the information provided will be used to help us decide how to support you and you will be contacted with an appointment, or for further information if needed based on your responses.
Please ensure that you fill in every field marked *