Midwife Registration Form

If you are pregnant, please complete this short form so you can be registered with thje Midwife team at the Royal Victoria Infirmary (RVI) in Newcastle.

It should only take a minute or two to fill in. Thank you for taking the time to check everything is accurate – it helps your care run more smoothly.

Name(Required)

First Last

Previous Name(s)

Date of Birth(Required)

NHS Number

Look up your NHS number online

Preferred Contact Phone Number(Required)

Estimated Due Date (EDD) or Last Menstrual Period date (LMP)

Marital Status

Ethnicity

Address(Required)

Street Address Address Line 2 City Post Code

Is this your first pregnancy at the RVI?(Required)

Yes

Is this a late booking – over 13 weeks gestation?(Required)

Yes

Are you eligible for NHS care?(Required)

Most people living in the UK are eligible for NHS care. If you are unsure, please select “Not sure” and we will check with you.

Yes

Not sure

Consent(Required)

I confirm the information entered is correct

CAPTCHA

This field is for validation purposes and should be left unchanged.