Antenatal Class Booking

About You

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email

Phone

Date of Birth

Marital Status

Employment

Living Arrangements

How did you hear about us?

About Your Pregnancy

Is this your first pregnancy

Yes
No

What is your due date?

Service Agreement

I have read, understand and agree with the information set out in the Limitation of Services listed below and request support from Stanton Healthcare East of Scotland

Stanton Healthcare East of Scotland (also known as SHE Pregnancy Support) is a registered Scottish charity and is a pregnancy support service. We welcome anyone in an unexpected pregnancy situation and women who need general pregnancy support. Our services are provided free of charge. We offer pregnancy tests, information, education, befriending and practical help through our antennal and postnatal classes.

Our services are not intended to be a substitute for NHS or pre-natal care or professional counselling. The information we offer is for general education and support only. For medical questions please seek advice from your GP or, in an emergency, dial 999. Stanton Healthcare does not provide either continuing or emergency medical care. You recognise that if you have any signs of bleeding, pain, or other pregnancy related health problems, you will seek further care at your GP or, in an emergency, dial 999. Stanton Healthcare will hold in the strict confidence all the information that the client provides, except under the following circumstances:

When there is reasonable suspicion of child abuse, whether the client is the victim of the abuser;

When there is reasonable suspicion of elder or dependent adult abuse;

When there is a threat of harm to a third party;

When there is a threat of self-inflicted harm;

When there is a threat against the centre itself. To the extent required by law, we will make a report to the proper authorities in the instance of suspected abuse or threat or harm.

GDPR Agreement

I consent to Stanton Healthcare East of Scotland holding and processing my data for the purposes of dealing with this form