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Pregnancy questionnaire

The Maternity clinic is run by midwives weekly. If you are pregnant then please complete the below form, which will be passed to the midwives who will then contact you to discuss your appointments.

Submit your request and the midwife will contact you to book your appointment around 8 to 10 weeks into your pregnancy.

You can use this service if you:

  • are registered at the surgery

Before you start

We’ll ask you for:

  • your first and last name, date of birth, sex, postcode, email and phone number
  • if applicable, the details of the person you are completing the form on behalf of
Start now

You can also phone us on New Mills Surgery 01663 743483 or Hayfield Surgery 01663 743483.

Page published: 26 January 2024
Last updated: 12 August 2025