Birth Center tours form

Haga clic aquí para registrarse en Español

  (Fill out 1 form per class)
* = required field
*First Name  
*Last Name  
*Address  
*City  
*State 
*Zip Code
*Language Requirement
Other language, if applicable
*Primary Phone
*eMail
*Birthdate  
Current HCMC Patient?
For your prenatal care, who do you see?  
Your Clinic Name  
Is this your  
first baby?  
Due Date  
* Class 
desired  

*Class  
date desired 

   
Insurance Company
 

Insurance information is only required for car seat classes. We bill insurance for the cost of most classes.

 

Group Number
Subscriber/Insurance Number

Thank you for completing this form!
 

Welcome to The Birth Center at HCMC's childbirth education video classes! Here you will find a variety of video topics to choose from. Please enter the password given to you by your provider.

Password: