Free pregnant papers 22Free pregnant papers 22Free pregnant papers 22
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Community Midwife
Community Midwifery Office
Warwick Hospital
Lakin Road
Warwick Road
CV34 5BW
Congratulations on your pregnancy. The National Institute of Clinical Excellence (2008, last updated March 2016)
recommend 400 mcg of Folic Acid to be taken ideally before conception and upon confirmation of pregnancy throughout
the first 12 weeks. A dose of vitamin D 10 mcg is also recommended during pregnancy and whilst breast feeding.
Please complete your details below and return to reception:
Name:
Address:
DOB:
Telephone No:

Can a Message be Left: Yes/No

NHS no:
Named GP:

GP Surgery:

1st Day of Last Menstrual period:
Do you consent to an Ultrasound scan: Yes/No
st

Is this your 1 pregnancy:

Yes/No

Smoker: Yes/No
If yes, would you like support to stop smoking in pregnancy? Yes/No
Do you require an interpreter? Yes/No

Language Required :

Please find attached my contact details and information on vitamin supplements in pregnancy, ultrasound scan
and screening tests for you and your