Maternity Exemption Certificate
Please use this form if you are requesting for a certificate for maternity exemption certificate. entitles a woman to free prescriptions and dental care. It is issued at any point during pregnancy
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Entitlement
A maternity exemption certificate entitles you for:

- free NHS dental treatment
- free NHS prescriptions, if you have a valid maternity exemption certificate
When it expires
Your certificate will expire 12 months after either:
- your due date
- the birth of your baby
Criteria
Entitles a woman to free prescriptions and dental care. It is issued at any point during pregnancy
https://www.nhsbsa.nhs.uk/exemption-certificates/maternity-exemption-certificates
YOUR DETAILS
Please include your latest personal details so that we can contact you if necessary
Your Full Name *
Your Date of Birth *
Please include your DOB in the form of DD/MM/YYYY i.e 01/01/1980
Your MOBILE number *
If we need to contact you to clarify your answers especially if your asthma is poorly controlled
Your EMAIL address *
MATERNITY EXEMPTION CERTIFICATE REQUEST
Are you pregnant? *
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