Self referral form

There is a technical issue with the Pregnancy Care Self-Referral form.

Your form has not been submitted, but you have the option of filling out a new form and trying again. If you wish to try again, it is recommended you wait at least 5 minutes before doing so. Please use this link to start a new Pregnancy Care Self-Referral form.

We apologise for any inconvenience and endeavour to have it available again shortly.

If your situation is an emergency, please call 000.

If you have any of the following seek advice from your doctor or go to your nearest Emergency Department:

• If you have red, fresh blood loss.
• If you feel your baby’s movements have changed, or you are worried about your baby’s movements.
• If you feel unwell (flu like symptoms) or are experiencing a burning or stinging sensation when passing urine
• If you have severe back pain
• If you have diarrhoea and or vomiting
• If you feel your stomach is tender, or you experience severe indigestion pain that you have not had before.
• If you feel faint or have fainted
• If you are experiencing signs of labour

To access usual pregnancy care services, please contact your local General Practitioner or Hospital via the Queensland Health Find a health service webpage.