Site information
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.
Who operates this referral route
This is an independent educational and referral website supporting Dr. Ali Al-Ibrahim’s maternal–fetal medicine practice; it is not Mediclinic’s corporate website. The responsible contact for this website form is the maternal–fetal medicine referral coordination team at referral@motherfetus.com.
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.
Healthcare-provider boundary
Submitting this form does not create an appointment or a patient relationship with Mediclinic. If care is arranged, the relevant healthcare provider’s privacy terms apply to the clinical records and care delivered there.
Access, correction, or deletion requests
For a question about a submission, or to request access, correction, or deletion while the information remains within this referral route, email referral@motherfetus.com and provide enough detail to identify the request. Once information forms part of a healthcare provider’s clinical record, requests must follow that provider’s privacy process and applicable retention requirements.
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.