Antenatal Care Self Referral

Rotunda Private

Antenatal Care Self Referral Form

The clinics are staffed by the same consultants who provide a state of the art women’s health service in the main Rotunda Hospital, which is the oldest working maternity hospital in the world, with a renowned reputation for excellence.

Antenatal Care Self Referral Form (1)

Make a Booking Online

The only Required Fields are Your Name, Your Email Address and Preferable means of contact.

If you have the extra time to fill in more information, this would be extremely helpful for our clinic team.

Thank you.

I wish to enquire/Make an appointment for;
- Private Care
- Semi-Private Care
Which Consultant would you like to attend?
Personal Details
Your Name*
First Last
Your Email Address*
Date of Birth (dd/mm/yyyy)
Contact Number
Preferred Means of Contact*
- Phone
- Email
- Either
Have you attended Rotunda Private before?
- Yes
- No
For Maternity Patients
First Day of Last Period
Current Gestation (if known)
Comments/Additonal Info
The Rotunda Private Hospital respects your rights to privacy. All personal data processed by staff in our Hospital is processed in accordance with the obligations of the current Data Protection legislation. The purpose of this website Privacy Policy is to outline how we deal with the personal data you provide to us while visiting this website. By visiting this website, you are accepting the terms and this website Privacy Policy Statement. This Policy describes how the Rotunda Hospital processes personal information of users collected through its website (https://rotundaprivate.ie) The Rotunda Hospital endeavours to safeguard the privacy rights of all patients, staff and visitors and will take all necessary steps to protect the fundamental rights and freedoms of individuals. This policy also describes options available to you, our end users and visitors regarding the Hospital's use of your personally identifiable information and what your rights are regarding access to, correction and deletion of data held by the Hospital.
Collection and use of personal information
The Rotunda Hospital does not collect any personal data about you on this website. Any information which you provide in this way is not made available to any third parties. We do not pass on any of your personal information when dealing with your inquiry, unless you have given us permission to do so. Any personal information which you choose to send us via our website will be treated with the highest standards of security and confidentiality in accordance with current Data Protection legislation.
Collection and use of technical information
Cookies: This website does not use cookies, apart from temporary "session" cookies, which enable a visitor's web browser to remember which pages on this website have already been visited. A cookie is a piece of data stored on the user's path through the site, and identifies repeat visits. It contains basic information about the user's identity, but no personal information. When the user closes their browser, the cookie is destroyed. You can set your computer not to accept cookies, without the loss of any functionality on this website.
Form and Visit Data
We delete any submitted form data after 30 days to protect your privacy. Technical details in connection with visits to this website are logged for statistical purposes. Statistical information gathered does not constitute "personal data" for the purposes of Data Protection law. Links to other websites You should be aware that: - If you access another site through a link we provide, you are subject to the privacy policy of that site - Links to other websites do not constitute an endorsement of that website by the Rotunda Hospital - Rotunda Hospital is not responsible for the content or privacy policies of any other websites to which you may find links on this website.
Agree to terms*
- Yes
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Rotunda Private

Antenatal Care Self Referral Form

Antenatal Care Self Referral Form (1)

Personal Details

For Maternity Patients

Collection and use of personal information

Collection and use of technical information

Form and Visit Data

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