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Privacy notice for referral forms
How information submitted through the patient self-referral form is transmitted, used, retained, and protected.
What we collect
The self-referral form asks for contact details, preferred language and location, limited pregnancy information, and the reason for referral. It does not request or accept file uploads. Please provide only the information needed for the team to understand and triage your request.
How the form is delivered
The form is processed by FormSubmit and delivered by email to the maternal–fetal medicine referral team at referral@motherfetus.com. FormSubmit states that form submissions may be retained in its archive for 30 days. Email systems may retain the message in accordance with the recipient organisation’s policies. The team will contact you and arrange any records needed after reviewing the request.
Purpose and consent
Your information is used to contact you, review the referral request, and direct you to an appropriate consultation or diagnostic pathway. It is not used here to make an automated clinical decision. You must actively consent before sending the form.
Your choices
You may instead use the established Fetus.ae contact route or call 800 2000. Do not use the form for emergencies. For heavy bleeding, severe abdominal pain, sudden fluid loss, reduced fetal movements, or another urgent concern, go to the nearest emergency department.