Your clinical details
First day of last menstrual period
Estimated delivery date
Preferred type of birth
Home birth/Open to a home assessment in labour
Oasis Birth Centre
Regarding any previous pregnancies, how many of the following have you had: Pregnancies
Pre-term babies (less than 37 weeks)
Miscarriages and terminations
Regarding previous births, how many times have you given birth by: Normal vaginal birth
Do you have any of the following health problems, if "yes" please give details:
Impaired Glucose Tolerance
Gestational Diabetes, now or in the past
High blood pressure
Have you have transferred your care from another maternity unit? If so please give details
Have you given birth before at the PRUH or King’s College Hospital?
Estimated date of your last smear
Result of your last smear
Past Gynae/Obstetric History
Past Medical/Surgical History
Details and dosage of your current medication (including folic acid)
Do you or the father of the baby have sickle cell disease or trait?
Do you or the father of the baby have thalassemia or thalassemia trait?
Past Gynae/Obstetric History
Maternity Notes - your online pregnancy records
You can choose to see your notes via an electronic system called Maternity Notes.
You can do this through a smartphone app or a website during your pregnancy. The system includes:
details of upcoming appointments
space to write your birth plan
links to national resources and websites
links to King’s patient information leaflets
How and why Maternity Notes uses your information
If you would like to see your pregnancy records online, confirm below that you consent to this
and provide the email and mobile phone number requested.
These allow us to set up secure three-step verification,
which is important because it ensures your personal health records can only be accessed by you.
Your email address will only be used by the hospital to contact you regarding this pregnancy.
It will be shared with Clevermed Ltd, the company that provides the Maternity Notes system.
It will not be shared with any other external organisations.
For further information about how your data will be used and stored, go to:
Check your email
If you consent to use Maternity Notes, please check your email regularly,
as this is how we will send you details of your first appointment with a midwife.
You may need to check your junk email folder or add email@example.com to your
contacts in advance.
The email we send you will include links to download the Maternity Notes app or login to the website.
We encourage you to enter some of your personal information into Maternity Notes before your booking appointment.
Please tick to confirm you have read about and understood the above information about Maternity Notes
Give consent to use Maternity Notes
Please tick to give consent to accessing your maternity records on an electronic system?
If consent given, please provide:
an email address, which only you can access
your personal mobile telephone number (you will receive a verification text message to this number when you first set up your account. This number will also be used if you forget your password)
Use email address already provided
Use contact number already provided